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General NPI Number Information
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NPI Number | 1538499314
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Entity Type | Organization
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Legal Business Name | JONATHAN T NEBB OD PA
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 13740 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32224-6033
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Country | US
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Telephone | 904-207-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 9734 TAPESTRY PARK CIR #405
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City | JACKSONVILLE
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State | FL
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Zip | 32246-9906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN NEBB
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Credential | O.D.
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Telephone | 703-447-1644
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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 | OPC4357
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License Number State | FL
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