Provider Demographics
NPI:1790453090
Name:WH FL OPTOMETRY PLLC
Entity Type:Organization
Organization Name:WH FL OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- WH FL OPTOMETRY PLLC
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEEPUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-204-1258
Mailing Address - Street 1:702 SW 8TH ST # MS 0445
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0445
Mailing Address - Country:US
Mailing Address - Phone:479-204-1258
Mailing Address - Fax:479-277-4331
Practice Address - Street 1:904 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3456
Practice Address - Country:US
Practice Address - Phone:407-861-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty