Provider Demographics
NPI:1407224405
Name:EVANS, JOE R III (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:EVANS
Suffix:III
Gender:M
Credentials:OD
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Mailing Address - Street 1:770 US HIGHWAY 331 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-3300
Mailing Address - Country:US
Mailing Address - Phone:850-892-5514
Mailing Address - Fax:850-892-0189
Practice Address - Street 1:770 US HIGHWAY 331 S
Practice Address - Street 2:SUITE 1
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3300
Practice Address - Country:US
Practice Address - Phone:850-892-5514
Practice Address - Fax:850-892-0189
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC 5138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist