Provider Demographics
NPI:1144289919
Name:GEIS, EVE BOGGESS (OD)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:BOGGESS
Last Name:GEIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4788 HODGES BLVD
Mailing Address - Street 2:UNIT 205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7222
Mailing Address - Country:US
Mailing Address - Phone:904-382-2037
Mailing Address - Fax:904-223-1274
Practice Address - Street 1:4788 HODGES BLVD
Practice Address - Street 2:UNIT 205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7222
Practice Address - Country:US
Practice Address - Phone:904-382-2037
Practice Address - Fax:904-223-1274
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPCOO2225152W00000X
FLOPC002225152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078072300Medicaid
FL078072300Medicaid