Provider Demographics
NPI:1487685145
Name:CONVERSE, JUNE LEA (OD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:LEA
Last Name:CONVERSE
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 1:7511 FOLK WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-5016
Mailing Address - Country:US
Mailing Address - Phone:863-853-1132
Mailing Address - Fax:863-853-1132
Practice Address - Street 1:3730 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809
Practice Address - Country:US
Practice Address - Phone:863-853-9606
Practice Address - Fax:863-853-9344
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85247Medicare UPIN
FL19542ZMedicare ID - Type Unspecified