Provider Demographics
NPI:1437397866
Name:NEBB, JONATHAN TYLER (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TYLER
Last Name:NEBB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9858 CLINT MOORE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1034
Mailing Address - Country:US
Mailing Address - Phone:703-447-1644
Mailing Address - Fax:
Practice Address - Street 1:9858 CLINT MOORE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1034
Practice Address - Country:US
Practice Address - Phone:703-447-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001780152W00000X
FLOPC4357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist