Provider Demographics
NPI:1407083603
Name:AZWELL, LINDA D (OD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:AZWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 N WILLIAMS ST
Mailing Address - Street 2:SUITE 108-149
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-8363
Mailing Address - Country:US
Mailing Address - Phone:352-804-2015
Mailing Address - Fax:
Practice Address - Street 1:11012 N WILLIAMS ST
Practice Address - Street 2:NEXT TO VISION CENTER
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8319
Practice Address - Country:US
Practice Address - Phone:352-465-9369
Practice Address - Fax:352-465-9371
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist