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Organization
HARRIS WILCOX AND DONOVAN PA
Active
Organization
HARRIS WILCOX AND DONOVAN PA
Active
Other names
Clay Eye Physicians and Surgeons PA/Fleming Island Optical
Organization subpart
No
Provider details
NPI number
Authorized official
LUCY DINGMAN (BILLING REPRESENTATIVE)
(904) 272-2020
Entity
Organization
Contact information
Practice address
2023 PROFESSIONAL CENTER DR, ORANGE PARK, FL 32073-4461
(904) 272-2020
(904) 272-5762
Mailing address
2023 PROFESSIONAL CENTER DR, ORANGE PARK, FL 32073-4461
(904) 272-2020
(904) 272-5762
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
156FC0800X
Contact Lens Technician/Technologist
—
NULL
156FC0800X
Contact Lens Technician/Technologist
—
—
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
332H00000X
Eyewear Supplier
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB1273
RAIL ROAD MEDICARE
FL
Enumeration date
08/31/2006
Last updated
06/27/2024
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