Organization
VASSALLO EYE INSTITUTE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M VASSALLO MD (OWNER)
(904) 797-7722
Entity
Organization
Contact information
Practice address
3780 US HIGHWAY 1 S, ST AUGUSTINE, FL 32086-7150
(904) 797-7722
Mailing address
PO BOX 1598, ST AUGUSTINE, FL 32085-1598
(904) 797-7722
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME59092
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006438500
—
FL
05
—
006438501
—
FL
01
—
12416
BCBS
FL
Enumeration date
03/04/2008
Last updated
03/12/2014
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