Provider Demographics
NPI:1124160395
Name:OKALOOSA EYE CARE PA
Entity type:Organization
Organization Name:OKALOOSA EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:RAYNA
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-683-0221
Mailing Address - Street 1:207 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3543
Mailing Address - Country:US
Mailing Address - Phone:850-683-0221
Mailing Address - Fax:850-683-0225
Practice Address - Street 1:207 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3543
Practice Address - Country:US
Practice Address - Phone:850-683-0221
Practice Address - Fax:850-683-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621064300Medicaid
FLU64579Medicare UPIN
FL621064300Medicaid
K9072Medicare PIN