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Organization
SUDDUTH VISION PLLC
Active
Organization
SUDDUTH VISION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON KIM SUDDUTH OD (OWNER/OPTOMETRIST)
(206) 419-5166
Entity
Organization
Contact information
Practice address
8000 PARRAMORE RD., JACKSONVILLE, FL 32244
(206) 419-5166
Mailing address
4538 POLARIS ST, JACKSONVILLE, FL 32205-5025
(206) 419-5166
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4882
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316370414
NPI
FL
Enumeration date
12/08/2017
Last updated
12/08/2017
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