Provider Demographics
NPI:1124078787
Name:TOMOKA EYE ASSOCIATES
Entity type:Organization
Organization Name:TOMOKA EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-506-8403
Mailing Address - Street 1:790 DUNLAWTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9279
Mailing Address - Country:US
Mailing Address - Phone:376-767-0053
Mailing Address - Fax:386-767-3490
Practice Address - Street 1:345 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3111
Practice Address - Country:US
Practice Address - Phone:376-672-4244
Practice Address - Fax:386-672-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256352503Medicaid
FLK0898Medicare PIN
FLDF0555Medicare PIN