Organization
EYE CENTER OF NORTH FLORIDA, P.A.
Active
Parent organization
EYE CENTER OF NORTH FLORIDA
Other names
Port St. Joe Office
Organization subpart
Yes
Provider details
NPI number
Legal business name
EYE CENTER OF NORTH FLORIDA
Authorized official
MS. KATHI NICHOLS (OFFICE MANAGER)
(850) 784-3937
Entity
Organization
Contact information
Practice address
528B 5TH ST, PORT ST JOE, FL 32456-1754
(850) 227-7266
(850) 229-2595
Mailing address
2500 MARTIN LUTHER KING JR. BLVD, PANAMA CITY, FL 32405-4412
(850) 784-3937
(850) 522-9829
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
207W00000X
Ophthalmology Physician
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740213529
GROUP NPI
FL
05
—
257952901
—
FL
01
—
45154C
BLUE CROSS & BLUE SHIELD
FL
01
—
CG6943
RR MEDICARE
FL
Enumeration date
09/13/2006
Last updated
04/20/2023
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