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General NPI Number Information
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NPI Number | 1083889455
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Entity Type | Organization
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Legal Business Name | DAVID J. UNDERILL OD
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 520 SOUTH PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974
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Country | US
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Telephone | 863-763-4334
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Fax | 863-763-3226
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Provider Business Mailing Address
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Address Line | 520 SOUTH PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974
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Country | US
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Telephone | 863-763-4334
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Fax | 863-763-3226
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Authorized Official
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Title or Position | MANAGER
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Name | SHELLY CARTER
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Credential |
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Telephone | 863-763-4334
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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 | OPC 001869
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License Number State | FL
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