# LOW VISION CENTER OF NORTHEAST FLORIDA INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235329848
- **Authorized official:** DR. TIFFANY E OWENS OD (CLINICAL DIRECTOR)
- **Authorized official phone:** (904) 389-9989

## Contact information

- **Practice address:** 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204-4710
- **Practice address phone:** (904) 389-9989
- **Practice address fax:** (904) 389-1060
- **Mailing address:** 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204-4710
- **Mailing address phone:** (904) 389-9989
- **Mailing address fax:** (904) 389-1060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC4045 | FL | Yes |

## Other

- **Enumeration date:** 07/30/2007
- **Last updated:** 06/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 28569 | BCBS | FL |
| 05 | — | 621075900 | — | FL |
| 01 | — | DE3862 | RAILROAD MEDICARE | — |