Healthcare Provider Details

I. General information

NPI: 1619431293
Provider Name (Legal Business Name): DAVID J FEENSTRA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8155 RED BUG LAKE RD STE 121
OVIEDO FL
32765-9266
US

IV. Provider business mailing address

302 BURLEIGH CT
WINTER SPRINGS FL
32708-4367
US

V. Phone/Fax

Practice location:
  • Phone: 407-492-1335
  • Fax:
Mailing address:
  • Phone: 407-492-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID FEENSTRA
Title or Position: OWNER/OD
Credential: OD
Phone: 407-492-1335