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General NPI Number Information
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NPI Number | 1528574753
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Entity Type | Organization
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Legal Business Name | DUNNELLON EYE CARE LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 20450 E PENNSYLVANIA AVE
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City | DUNNELLON
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State | FL
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Zip | 34432-6030
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Country | US
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Telephone | 352-465-0024
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Fax | 352-465-0026
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Provider Business Mailing Address
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Address Line | 11150 N WILLIAMS ST STE 108-149
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City | DUNNELLON
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State | FL
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Zip | 34432-8363
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Country | US
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Telephone | 352-465-0024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINDA AZWELL
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Credential | OD
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Telephone | 352-804-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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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 |
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License Number State |
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