Organization
RIVERSIDE EYE AND LASER SPECIALISTS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRITTANY R. AGEE M.D. (OWNER)
(904) 355-1525
Entity
Organization
Contact information
Practice address
1034 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4123
(904) 354-2114
(904) 354-2122
Mailing address
1034 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4123
(904) 354-2114
(904) 354-2122
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151LL
BLUE CROSS AND BLUE SHIELD
FL
Enumeration date
09/19/2018
Last updated
09/19/2018
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