Provider Demographics
NPI:1275740839
Name:EYE SURGERY CENTER OF NORTH FLORIDA LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF NORTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:702-432-2594
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8545
Mailing Address - Country:US
Mailing Address - Phone:904-296-0098
Mailing Address - Fax:904-293-4331
Practice Address - Street 1:7205 BENTLEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7565
Practice Address - Country:US
Practice Address - Phone:904-296-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00445115OtherMEDICARE RAILROAD
FL66IOtherBCBS
FLP00445115OtherMEDICARE RAILROAD
FL001031700Medicaid