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General NPI Number Information
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NPI Number | 1063573574
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Entity Type | Organization
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Legal Business Name | ASSOCIATED OPTOMETRISTS OF OVERHOLSER & OVERHOLSER OD PA
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 17961 S HIGHWAY 441
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City | SUMMERFIELD
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State | FL
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Zip | 34491
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Country | US
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Telephone | 352-307-4435
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Fax | 352-307-4437
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Provider Business Mailing Address
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Address Line | 21455 NW 39TH CT
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City | MICANOPY
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State | FL
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Zip | 32667
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Country | US
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Telephone | 352-875-1173
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Fax | 352-237-9479
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. TERRIE JO OVERHOLSER
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Credential | O.D.
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Telephone | 352-875-1173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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