Healthcare Provider Details

I. General information

NPI: 1720312440
Provider Name (Legal Business Name): MOBILE DOCTORS OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 79TH STREET CSWY 2006
NORTH BAY VILLAGE FL
33141-4222
US

IV. Provider business mailing address

1881 79TH STREET CSWY 2006
NORTH BAY VILLAGE FL
33141-4222
US

V. Phone/Fax

Practice location:
  • Phone: 305-439-2015
  • Fax: 305-675-0443
Mailing address:
  • Phone: 305-717-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4397
License Number StateFL

VIII. Authorized Official

Name: DR. JASON XUNA
Title or Position: PRESIDENT
Credential: OD
Phone: 305-717-8181