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General NPI Number Information
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NPI Number | 1821881137
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Entity Type | Individual
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Provider Name | JOHN SIKES LICENSED OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 5100 OKEECHOBEE RD
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City | FORT PIERCE
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State | FL
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Zip | 34947-5428
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Country | US
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Telephone | 772-465-2547
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Fax | 772-465-7312
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Provider Business Mailing Address
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Address Line | 303 SW LAKE FOREST WAY
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2072
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Country | US
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Telephone | 206-683-1425
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO7037
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License Number State | FL
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