Provider Demographics
NPI:1720128655
Name:WOLCHOK, EUGENE B (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:B
Last Name:WOLCHOK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3636 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4250
Mailing Address - Country:US
Mailing Address - Phone:904-739-0606
Mailing Address - Fax:904-739-0609
Practice Address - Street 1:3636 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE A-2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4250
Practice Address - Country:US
Practice Address - Phone:904-739-0606
Practice Address - Fax:904-739-0609
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME24163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53074Medicare UPIN
FL16881XMedicare PIN