Individual
DEBORAH J FANTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
14 S POLK AVE, ARCADIA, FL 34266-3950
(863) 993-9911
(863) 993-1022
Mailing address
14 S POLK AVE, ARCADIA, FL 34266-3950
(863) 993-9911
(863) 993-1022
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO 4027
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650942504
TAX ID
FL
Enumeration date
04/11/2008
Last updated
04/11/2008
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