NPIMap

Organization Active NPI

Atlantic Eye Institute, P.a.

  • Ophthalmology Physician
  • Jacksonville Beach, FL
National Provider Identifier
1033200241
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ATLANTIC EYE INSTITUTE, P.A.
Practice address
3316 3Rd St S Ste 103
Jacksonville Beach, FL 32250-6090
Phone
(904) 595-5122
Fax
(904) 249-2352
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Candice B Davis
Title
Chief Revenue Officer
Phone
(916) 990-7590

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

3316 3Rd St S Ste 103
Jacksonville Beach, FL 32250-6090

Mailing address

3316 3Rd St S
Suite 103
Jacksonville Beach, FL 32250-6073
Phone (904) 241-7865

Other practice location 1

6207 Bennett Rd
Jacksonville, FL 32216-5007
Phone (904) 731-7500

Other practice location 2

105 Nature Walk Pkwy Unit 105
St Augustine, FL 32092-4903
Phone (904) 241-7865

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603001518 FL Part B Supplier - Clinic/Group Practice 2466434386 Receives reassigned benefits from 10 practitioners
Practice locations: Jacksonville Beach, FL; St Augustine, FL; Jacksonville, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Atlantic Eye Institute5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13457 Atlantic Blvd
Ste 4
Jacksonville, FL 32225

3316 3rd St S
Ste 103
Jax Bch, FL 32250
Phone (904) 241-7865

105 Nature Walk Pkwy
Unit 105
St Augustine, FL 32092
Phone (904) 241-7865

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1033200241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3316 3RD ST S",
            "address_2": "SUITE 103",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506073",
            "telephone_number": "904-241-7865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3316 3RD ST S STE 103",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506090",
            "telephone_number": "904-595-5122",
            "fax_number": "904-249-2352"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6207 Bennett Rd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322165007",
            "country_code": "US",
            "telephone_number": "904-731-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Nature Walk Pkwy Unit 105",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320924903",
            "country_code": "US",
            "telephone_number": "904-241-7865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATLANTIC EYE INSTITUTE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF REVENUE OFFICER",
        "authorized_official_telephone_number": "916-990-7590"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.