Provider Demographics
NPI:1871901934
Name:FAMILY EYE CARE OF PALM COAST, INC
Entity type:Organization
Organization Name:FAMILY EYE CARE OF PALM COAST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHALKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-225-4553
Mailing Address - Street 1:4 OFFICE PARK DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3855
Mailing Address - Country:US
Mailing Address - Phone:386-225-4553
Mailing Address - Fax:386-225-4558
Practice Address - Street 1:4 OFFICE PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3855
Practice Address - Country:US
Practice Address - Phone:386-225-4553
Practice Address - Fax:386-225-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3585261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1316998529OtherNPI
FL000095900Medicaid