# LAKE CITY EYE PHYSICIANS, LLC

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

## Provider details

- **NPI number:** 1235350208
- **Authorized official:** DR. REAVES C CLOE O.D. (OWNER)
- **Authorized official phone:** (386) 754-6616

## Contact information

- **Practice address:** 621 SW BAYA DR, SUITE 101, LAKE CITY, FL 32025-4240
- **Practice address phone:** (386) 754-6616
- **Practice address fax:** (386) 754-6615
- **Mailing address:** 621 SW BAYA DR, SUITE 101, LAKE CITY, FL 32025-4240
- **Mailing address phone:** (386) 754-6616
- **Mailing address fax:** (386) 754-6615

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 0700004320 | FL | Yes |

## Other

- **Enumeration date:** 05/01/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 19899 | BCBS | FL |