Provider Demographics
NPI:1922215755
Name:HARPER, JULIE ELAINE (LDO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELAINE
Last Name:HARPER
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 1:8877 CALUMET BLVD
Mailing Address - Street 2:
Mailing Address - City:PT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-3357
Mailing Address - Country:US
Mailing Address - Phone:941-475-7784
Mailing Address - Fax:941-475-7891
Practice Address - Street 1:461 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3701
Practice Address - Country:US
Practice Address - Phone:941-475-7784
Practice Address - Fax:941-475-7891
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4172156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6303005Medicaid