# JACK N SPERRY JR O.D. PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609145507
- **Authorized official:** DR. JACK N SPERRY JR. O. D. (PRESIDENT)
- **Authorized official phone:** (352) 551-5612

## Contact information

- **Practice address:** 720 LAKE DORA DR, TAVARES, FL 32778-3314
- **Practice address phone:** (352) 551-5612
- **Mailing address:** 720 LAKE DORA DR, TAVARES, FL 32778-3314
- **Mailing address phone:** (352) 551-5612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC2330 | FL | Yes |

## Other

- **Enumeration date:** 12/21/2011
- **Last updated:** 11/05/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078942900 | — | FL |
| 01 | — | 20357 | MEDICARE PROVIDER | FL |