Individual
DR. JOHN TIVNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
407 AVENUE K SE, WINTER HAVEN, FL 33880-4126
(863) 294-3504
(863) 299-0096
Mailing address
407 AVENUE K SE, WINTER HAVEN, FL 33880-4126
(863) 294-3504
(863) 299-0096
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 1060
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078082100
—
FL
Enumeration date
06/02/2005
Last updated
07/08/2007
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