Provider Demographics
NPI:1639327547
Name:VAWTER, ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VAWTER
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 1:4001 1ST ST # US41
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4431
Mailing Address - Country:US
Mailing Address - Phone:941-745-9800
Mailing Address - Fax:941-749-2863
Practice Address - Street 1:4001 1ST ST # US41
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4431
Practice Address - Country:US
Practice Address - Phone:941-745-9800
Practice Address - Fax:941-749-2863
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist