Provider Demographics
NPI:1194845008
Name:DUNDEE, JIMMY STEVEN
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:STEVEN
Last Name:DUNDEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 ROLLING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2317
Mailing Address - Country:US
Mailing Address - Phone:727-784-2014
Mailing Address - Fax:
Practice Address - Street 1:100 INDIAN ROCKS RD N
Practice Address - Street 2:
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-1778
Practice Address - Country:US
Practice Address - Phone:727-584-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1169156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0954370001Medicare ID - Type UnspecifiedOPTICAN