Provider Demographics
NPI:1518104991
Name:POWELL, JAMES LAVANCE III (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAVANCE
Last Name:POWELL
Suffix:III
Gender:M
Credentials:OD
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Mailing Address - Street 1:9365 ATLANTIC BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8218
Mailing Address - Country:US
Mailing Address - Phone:904-721-0704
Mailing Address - Fax:904-721-0706
Practice Address - Street 1:9365 ATLANTIC BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8218
Practice Address - Country:US
Practice Address - Phone:904-721-0704
Practice Address - Fax:904-721-0706
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2022-07-01
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Provider Licenses
StateLicense IDTaxonomies
FLOPC 4052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist