Provider Demographics
NPI:1477644128
Name:ORR, PENNY J (OD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:J
Last Name:ORR
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 1:11176 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1640
Mailing Address - Country:US
Mailing Address - Phone:239-594-0124
Mailing Address - Fax:239-594-1040
Practice Address - Street 1:11176 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1640
Practice Address - Country:US
Practice Address - Phone:239-594-0124
Practice Address - Fax:239-594-1040
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84880800Medicaid
FLU24972Medicare UPIN
FL84880800Medicaid