Organization
LOW VISION CENTER OF NORTHEAST FLORIDA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIFFANY E OWENS OD (CLINICAL DIRECTOR)
(904) 389-9989
Entity
Organization
Contact information
Practice address
2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204-4710
(904) 389-9989
(904) 389-1060
Mailing address
2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204-4710
(904) 389-9989
(904) 389-1060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4045
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28569
BCBS
FL
05
—
621075900
—
FL
01
—
DE3862
RAILROAD MEDICARE
—
Enumeration date
07/30/2007
Last updated
06/25/2008
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