Provider Demographics
NPI:1851475172
Name:PURCELL, DONALD GLENN (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GLENN
Last Name:PURCELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3740 S RIDGEWOOD AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3519
Mailing Address - Country:US
Mailing Address - Phone:386-492-6999
Mailing Address - Fax:386-492-6900
Practice Address - Street 1:3740 S RIDGEWOOD AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3519
Practice Address - Country:US
Practice Address - Phone:386-492-6999
Practice Address - Fax:386-492-6900
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2350152W00000X
FLOPC3512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC3512OtherSTATE LINCENSE #
SC2350OtherSC BOARD OF OPTOMETRY