Individual
MS. JUDY L DEITRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
2631 DUNN AVE, JACKSONVILLE, FL 32218-4656
(904) 765-3611
(904) 765-4256
Mailing address
2631-3 DUNN AVE, JACKSONVILLE, FL 32218-4693
(904) 765-3611
(904) 765-4256
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
2024
FL
Other
Enumeration date
01/05/2007
Last updated
08/05/2008
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