Provider Demographics
NPI:1043686256
Name:HEALTHYEYE DBA VISION EXPRESS LLC
Entity type:Organization
Organization Name:HEALTHYEYE DBA VISION EXPRESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-686-1386
Mailing Address - Street 1:4871 TOWN CENTER PARKWAY #5
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246
Mailing Address - Country:US
Mailing Address - Phone:904-686-1386
Mailing Address - Fax:904-686-1363
Practice Address - Street 1:4871 TOWN CENTER PARKWAY #5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:904-686-1386
Practice Address - Fax:904-686-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621174700Medicaid