Organization
M. F. DIFFENDALL OD PA
Active
Other names
Jacksonville Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL F DIFFENDALL OD (OWNER)
(410) 628-1510
Entity
Organization
Contact information
Practice address
3332 PAPER MILL RD, PHOENIX, MD 21131-1419
(410) 628-1510
Mailing address
3332 PAPER MILL RD, PHOENIX, MD 21131-1419
(410) 628-1510
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1372
MD
Other
Enumeration date
09/02/2012
Last updated
11/14/2013
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