Healthcare Provider Details

I. General information

NPI: 1528574753
Provider Name (Legal Business Name): DUNNELLON EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20450 E PENNSYLVANIA AVE
DUNNELLON FL
34432-6030
US

IV. Provider business mailing address

11150 N WILLIAMS ST STE 108-149
DUNNELLON FL
34432-8363
US

V. Phone/Fax

Practice location:
  • Phone: 352-465-0024
  • Fax: 352-465-0026
Mailing address:
  • Phone: 352-465-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA AZWELL
Title or Position: OWNER
Credential: OD
Phone: 352-804-2015