Healthcare Provider Details

I. General information

NPI: 1962448670
Provider Name (Legal Business Name): WILLIAM J OKTAVEC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PLACE #106
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

100 WHETSTONE PLACE #106
ST AUGUSTINE FL
32086
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:
Title or Position:
Credential:
Phone: