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General NPI Number Information
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NPI Number | 1316370414
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Entity Type | Individual
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Provider Name | BRANDON SUDDUTH O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 11406 SAN JOSE BLVD STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7953
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Country | US
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Telephone | 904-260-3839
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Fax | 904-260-3604
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Provider Business Mailing Address
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Address Line | 11406 SAN JOSE BLVD STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7953
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Country | US
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Telephone | 904-260-3839
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Fax | 904-260-3604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC4882
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | APPLYING
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License Number State | FL
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