Basic Information
| Provider Information | |||||||||
| NPI: | 1548937022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WH FL OPTOMETRY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 SW 8TH ST # MS 0445 | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727160445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792041258 | ||||||||
| FaxNumber: | 4792774331 | ||||||||
| Practice Location | |||||||||
| Address1: | 11900 ATLANTIC BLVD UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322252920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046418088 | ||||||||
| FaxNumber: | 9046418032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | MOHEEPUTH | ||||||||
| AuthorizedOfficialFirstName: | GLENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER WH FL OPTOMETRY PLLC | ||||||||
| AuthorizedOfficialTelephone: | 4792041258 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.