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General NPI Number Information
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NPI Number | 1508036658
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Entity Type | Organization
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Legal Business Name | ANTHONY J POTOCHICK OD PA
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 2036 FORBES ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3802
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Country | US
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Telephone | 904-387-4057
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Fax | 904-387-1026
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Provider Business Mailing Address
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Address Line | 2036 FORBES ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3802
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Country | US
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Telephone |
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Fax | 904-387-1026
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY JAMES POTOCHICK
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Credential | OD
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Telephone | 907-387-4057
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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 | OPC2902
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License Number State | FL
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