Provider Demographics
NPI:1740575323
Name:DR. LINDA AZWELL OD LLC
Entity Type:Organization
Organization Name:DR. LINDA AZWELL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-804-2015
Mailing Address - Street 1:11150 N WILLIAMS ST
Mailing Address - Street 2:SUITE 108-149
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-8363
Mailing Address - Country:US
Mailing Address - Phone:352-804-2015
Mailing Address - Fax:
Practice Address - Street 1:11012 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8319
Practice Address - Country:US
Practice Address - Phone:352-465-0024
Practice Address - Fax:352-465-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty