Provider Demographics
NPI:1366611840
Name:NORMAN S BATEH O D P A
Entity type:Organization
Organization Name:NORMAN S BATEH O D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-874-6531
Mailing Address - Street 1:1233 LANE AVE S STE 31
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6254
Mailing Address - Country:US
Mailing Address - Phone:904-781-6770
Mailing Address - Fax:904-781-9403
Practice Address - Street 1:1233 LANE AVE S STE 31
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6254
Practice Address - Country:US
Practice Address - Phone:904-781-6770
Practice Address - Fax:904-764-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078407900Medicaid
FL19262BMedicare PIN
FL1226260001Medicare NSC
FLT84229Medicare UPIN