Provider Demographics
NPI:1679799555
Name:MORRIS, JANET M (OD PA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:MORRIS
Suffix:
Gender:F
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 IDELL LANE
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571
Mailing Address - Country:US
Mailing Address - Phone:850-995-1513
Mailing Address - Fax:850-995-8638
Practice Address - Street 1:4965 HWY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571
Practice Address - Country:US
Practice Address - Phone:850-995-1513
Practice Address - Fax:850-995-1513
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20691AMedicare ID - Type Unspecified
T79186Medicare UPIN