Individual
EDWIN DETWEILER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6002 POINTE WEST BLVD, BRADENTON, FL 34209-5531
(941) 792-2020
(941) 782-1089
Mailing address
6002 POINTE WEST BLVD, BRADENTON, FL 34209-5531
(941) 792-2020
(941) 782-1089
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4016
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621086400
—
FL
Enumeration date
11/17/2005
Last updated
03/12/2019
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