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Organization
MARY M FUTCH OD PA
Active
Organization
MARY M FUTCH OD PA
Active
Other names
Baker Vision Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY MARTHA FUTCH OD (PRESIDENT)
(904) 259-6259
Entity
Organization
Contact information
Practice address
31 S 6TH ST, MACCLENNY, FL 32063-2311
(904) 259-6259
(904) 259-3436
Mailing address
31 S 6TH ST, MACCLENNY, FL 32063-2311
(904) 259-6259
(904) 259-3436
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 2517
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356361208
NPI
FL
01
—
1508122854
NPI
FL
01
—
20312
BCBS
FL
05
—
620401500
—
FL
01
—
OC0002221
PHARMACY CERTIFICATION
—
Enumeration date
04/11/2012
Last updated
08/06/2012
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