Organization
PARK AVENUE OPHTHALMICS, PLLC
Active
Other names
Advanced Eye Cre of Bay Cn
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN R HASTY M.D. (PRESIDENT)
(850) 784-3936
Entity
Organization
Contact information
Practice address
2500 W 23RD ST, PANAMA CITY, FL 32405-2349
(850) 784-3936
(850) 784-3539
Mailing address
2500 W 23RD ST, PANAMA CITY, FL 32405-2349
(850) 784-3936
(850) 784-3539
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259391200
—
FL
01
—
38903
BCBS FL
FL
01
—
CM3172
MEDICARE RETIRED RAILROAD
—
Enumeration date
06/03/2006
Last updated
03/13/2023
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