MEDICARE: WH FL OPTOMETRY PLLC

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1699442178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WH FL OPTOMETRY PLLC

Provider Business Mailing Address
First Line	:	702 SW 8TH ST # MS 0445
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-204-1258
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	7075 COLLINS RD UNIT 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5041
Country	:	US
Telephone Number	:	904-365-2555
Fax Number	:	904-772-1575

Authorized Official
Title or Position	:	OWNER WH FL OPTOMETRY PLLC
Name	:	GLENDA MOHEEPUTH
Credential	:
Telephone Number	:	479-204-1258

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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Directions to “WH FL OPTOMETRY PLLC ” Practice Location

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