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General NPI Number Information
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NPI Number | 1982893426
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Entity Type | Individual
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Provider Name | NORMAN LEE HERSKOVICH O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 2500 S KIRKMAN RD
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City | ORLANDO
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State | FL
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Zip | 32811-2345
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Country | US
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Telephone | 917-674-7457
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Fax | 954-208-7456
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Provider Business Mailing Address
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Address Line | 13506 SUMMERPORT VILLAGE PKWY STE 254
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City | WINDERMERE
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State | FL
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Zip | 34786-7366
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Country | US
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Telephone | 917-674-7457
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Fax | 954-208-7456
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3236
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License Number State | FL
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