Healthcare Provider Details

I. General information

NPI: 1588870505
Provider Name (Legal Business Name): DEBBIE SHEILA FORREST O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 CONROY RD SPACE L-201
ORLANDO FL
32839-2400
US

IV. Provider business mailing address

4200 CONROY RD SPACE L-201
ORLANDO FL
32839-2400
US

V. Phone/Fax

Practice location:
  • Phone: 407-903-1018
  • Fax: 407-903-1066
Mailing address:
  • Phone: 407-903-1018
  • Fax: 407-903-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC2961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOPC 2961
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: