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Organization
JACK N SPERRY JR O.D. PA
Active
Organization
JACK N SPERRY JR O.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK N SPERRY JR. O. D. (PRESIDENT)
(352) 551-5612
Entity
Organization
Contact information
Practice address
720 LAKE DORA DR, TAVARES, FL 32778-3314
(352) 551-5612
Mailing address
720 LAKE DORA DR, TAVARES, FL 32778-3314
(352) 551-5612
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC2330
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078942900
—
FL
01
—
20357
MEDICARE PROVIDER
FL
Enumeration date
12/21/2011
Last updated
11/05/2012
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