Healthcare Provider Details

I. General information

NPI: 1225380504
Provider Name (Legal Business Name): PRIMARY OPTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 HIGHWAY 466
LADY LAKE FL
32159-6338
US

IV. Provider business mailing address

PO BOX 2447
LADY LAKE FL
32158-2447
US

V. Phone/Fax

Practice location:
  • Phone: 352-259-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON BURRESS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 352-259-7994