Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO1169 | FL |
NPI | 1194845008 |
---|---|
Provider Name | Jimmy Steven Dundee |
First Address | Dunedin, FL 34698-2317 |
Second Address | Belleair Bluffs, FL 33770-1778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |