=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891760195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERLEVICH, OD & KROL, OD P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2006
-----------------------------------------------------
Last Update Date | 09/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4650 NW 39TH PLACE SUITE D
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-373-0000
-----------------------------------------------------
Fax | 352-373-0595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4650 NW 39TH PLACE SUITE D
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32606-8157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-373-0000
-----------------------------------------------------
Fax | 352-376-8908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRES
-----------------------------------------------------
Name | DR. NANCY E. HERLEVICH
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 352-373-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------