Avonda, William Mark

Avonda, William Mark is an individual health care provider with primary practice located at 1615 Sw Main Blvd , Lake City FL 32025-1108. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Avonda, William Mark can be contacted via phone (386) 755-2785.

Contact Information

Primary practice address
1615 Sw Main Blvd Lake City FL 32025-1108
Phone: (386) 755-2785
Fax: (386) 755-1128
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OPC3868 Florida
Eye and Vision Services Providers / Optometrist 152W00000X OB3177 Florida

Profile Details

NPI number 1710919170
LBN Legal business name Avonda, William Mark
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2006
Last updated Mar 21st, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710919170 NPPES
Other 1180560001 MEDICARE DMERC
Other 25000 MEDICARE DMERC
MEDICAID 620978500 MEDICARE DMERC
MEDICAID 001933700 MEDICARE DMERC
Other 297390 MEDICARE DMERC
MEDICAID 620978501 MEDICARE DMERC
Other 7155780 MEDICARE DMERC
Other P00208868 MEDICARE DMERC

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