# VASSALLO EYE INSTITUTE PA

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

## Provider details

- **NPI number:** 1730359043
- **Authorized official:** JOHN M VASSALLO MD (OWNER)
- **Authorized official phone:** (904) 797-7722

## Contact information

- **Practice address:** 3780 US HIGHWAY 1 S, ST AUGUSTINE, FL 32086-7150
- **Practice address phone:** (904) 797-7722
- **Mailing address:** PO BOX 1598, ST AUGUSTINE, FL 32085-1598
- **Mailing address phone:** (904) 797-7722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME59092 | FL | Yes |

## Other

- **Enumeration date:** 03/04/2008
- **Last updated:** 03/12/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 006438500 | — | FL |
| 05 | — | 006438501 | — | FL |
| 01 | — | 12416 | BCBS | FL |