Healthcare Provider Details

I. General information

NPI: 1053504415
Provider Name (Legal Business Name): WILLIAM J OKTAVEC MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL SUITE 106
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

100 WHETSTONE PL SUITE 106
ST AUGUSTINE FL
32086-5774
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-3937
  • Fax: 904-826-3977
Mailing address:
  • Phone: 904-826-3937
  • Fax: 904-826-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0046211
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM J OKTAVEC
Title or Position: CEO, OWNER
Credential: M.D
Phone: 904-826-3937