Organization
CONGLETON EYE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE CONGLETON O.D. (PRESIDENT)
(850) 455-0722
Entity
Organization
Contact information
Practice address
4600 MOBILE HWY, SUITE 122, PENSACOLA, FL 32506
(850) 455-0722
(850) 455-0723
Mailing address
4600 MOBILE HWY #9, PMB 139, PENSACOLA, FL 32506
(850) 455-0722
(850) 455-0723
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IG569A
MEDICARE GROUP PTAN
FL
01
—
IG570Z
FLORIDA MEDICARE - INDIVIDUAL PTAN
—
Enumeration date
06/09/2015
Last updated
09/25/2015
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