Organization
DURHAM OPTICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WADE THOMAS DURHAM OPTICIAN (CEO/PRESIDENT)
(352) 568-0442
Entity
Organization
Contact information
Practice address
940 N MAIN ST, BUSHNELL, FL 33513-5008
(352) 568-0442
(352) 568-2902
Mailing address
940 N MAIN ST, BUSHNELL, FL 33513-5008
(352) 568-0442
(352) 568-2902
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO1085
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086841800
—
FL
Enumeration date
06/04/2008
Last updated
06/04/2008
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