Provider Demographics
NPI:1639604762
Name:POPPER, GINGER (LDO)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:POPPER
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 161
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3120
Mailing Address - Country:US
Mailing Address - Phone:561-798-9001
Mailing Address - Fax:561-333-9559
Practice Address - Street 1:10300 FOREST HILL BLVD
Practice Address - Street 2:SUITE 161
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3120
Practice Address - Country:US
Practice Address - Phone:561-798-9001
Practice Address - Fax:561-333-9559
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDO5694156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician