Individual
JESSICA MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4211 US HIGHWAY 27 N, SEBRING, FL 33870-1917
(863) 658-3003
(863) 385-1233
Mailing address
13904 N DALE MABRY HWY STE 200, TAMPA, FL 33618-2446
(813) 908-2020
(813) 908-2133
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC5280
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018930100
—
FL
Enumeration date
09/15/2016
Last updated
02/15/2019
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