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General NPI Number Information
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NPI Number | 1932439395
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Entity Type | Organization
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Legal Business Name | DONALD G. PURCELL, O.D., P.A.
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 1700 W INTERNATIONAL SPEEDWAY BLVD SUITE # 432
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1387
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Country | US
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Telephone | 386-255-9585
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Fax | 386-255-3404
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Provider Business Mailing Address
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Address Line | 1700 W INTERNATIONAL SPEEDWAY BLVD SUITE # 432
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1387
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Country | US
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Telephone | 386-255-9585
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Fax | 386-255-3404
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD GLENN PURCELL
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Credential | O.D.
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Telephone | 386-255-9585
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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 | OPC003512
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License Number State | FL
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