Provider Demographics
NPI:1093599896
Name:SULLIVAN, HELEN (LDO)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 DUNN AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4870
Mailing Address - Country:US
Mailing Address - Phone:904-757-5222
Mailing Address - Fax:904-757-5011
Practice Address - Street 1:9890 HUTCHINSON PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7205
Practice Address - Country:US
Practice Address - Phone:904-721-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2189156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician