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General NPI Number Information
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NPI Number | 1265883797
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Entity Type | Organization
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Legal Business Name | PREVMED OPTOMETRY GROUP, PA
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 2011 FLAGLER AVE
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City | KEY WEST
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State | FL
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Zip | 33040-3732
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Country | US
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Telephone | 317-522-2054
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Fax | 855-671-4102
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Provider Business Mailing Address
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Address Line | 1499 WINDHORST WAY STE 120
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City | GREENWOOD
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State | IN
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Zip | 46143-8800
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Country | US
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Telephone | 317-522-2054
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Fax | 855-671-4102
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Authorized Official
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Title or Position | VP OF FINANACE
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Name | CLAUDIA JACKSON
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Credential |
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Telephone | 317-522-2054
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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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