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General NPI Number Information
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NPI Number | 1245750058
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Entity Type | Organization
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Legal Business Name | SUSAN S WHALEY OD LLC
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2858 MAHAN DR STE 4
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5472
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Country | US
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Telephone | 850-216-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2858 MAHAN DR STE 4
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5472
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Country | US
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Telephone | 850-216-2020
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JUDI WILFORD
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Credential |
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Telephone | 850-216-2020
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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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