| |
206 Ashourian Ave Ste 215, Saint Augustine, FL 32092-5107 | |
(904) 296-0098 | |
(904) 346-0559 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 206 Ashourian Ave Ste 215, Saint Augustine, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1770987836 | NPI | - | NPPES |
253273500 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
206 Ashourian Ave Ste 215, Saint Augustine, FL 32092-5107 Ph: (904) 296-0098 | 206 Ashourian Ave Ste 215, Saint Augustine, FL 32092-5107 Ph: (904) 296-0098 |