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NPI Code Detail

MEDICARE: JONATHAN T NEBB OD PA

MEDICARE: JONATHAN T NEBB OD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC4357FL

General Provider Information

NPI Number : 1538499314
Entity Type Code : Organization
Provider Name (Legal Business Name) : JONATHAN T NEBB OD PA
Provider Business Mailing Address
First Line : 9734 TAPESTRY PARK CIR
Second Line : #405
City : JACKSONVILLE
State : FL
Zip : 32246-9906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13740 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-6033
Country : US
Telephone Number : 904-207-7077
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JONATHAN NEBB
Credential : O.D.
Telephone Number : 703-447-1644
Provider Enumeration Date : 12/30/2009
Last Update Date : 06/03/2010

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