Healthcare Provider Details

I. General information

NPI: 1477442192
Provider Name (Legal Business Name): JULIA SUPLICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E ATLANTIC AVE
DELRAY BEACH FL
33483-4535
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 561-279-4444
  • Fax: 561-279-4101
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: