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General NPI Number Information
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NPI Number | 1801191960
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Entity Type | Organization
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Legal Business Name | SAMUEL HATHY III,O.D.
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 11111 SAN JOSE BLVD STE 44
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7274
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Country | US
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Telephone | 904-292-3976
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Fax | 904-292-5322
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Provider Business Mailing Address
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Address Line | 11111-44 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32223
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Country | US
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Telephone | 904-292-3976
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Fax | 904-292-5322
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SAMUEL HATHY III
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Credential | O.D.
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Telephone | 904-292-3976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | FL-OPC-2361
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License Number State | FL
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