# PARK AVENUE OPHTHALMICS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Eye Cre of Bay Cn
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164460069
- **Authorized official:** BENJAMIN R HASTY M.D. (PRESIDENT)
- **Authorized official phone:** (850) 784-3936

## Contact information

- **Practice address:** 2500 W 23RD ST, PANAMA CITY, FL 32405-2349
- **Practice address phone:** (850) 784-3936
- **Practice address fax:** (850) 784-3539
- **Mailing address:** 2500 W 23RD ST, PANAMA CITY, FL 32405-2349
- **Mailing address phone:** (850) 784-3936
- **Mailing address fax:** (850) 784-3539

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 03/13/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 259391200 | — | FL |
| 01 | — | 38903 | BCBS FL | FL |
| 01 | — | CM3172 | MEDICARE RETIRED RAILROAD | — |