Provider Demographics
NPI:1649470766
Name:ISLAND EYECARE PA
Entity type:Organization
Organization Name:ISLAND EYECARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAMSETT-SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-278-1760
Mailing Address - Street 1:1515 BUSINESS CENTER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4401
Mailing Address - Country:US
Mailing Address - Phone:904-278-1760
Mailing Address - Fax:904-278-1730
Practice Address - Street 1:1515 BUSINESS CENTER DR STE 4
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4401
Practice Address - Country:US
Practice Address - Phone:904-278-1760
Practice Address - Fax:904-278-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1004030001Medicare NSC
BG018Medicare PIN