Provider Demographics
NPI:1205906575
Name:HILGENDORF, DONNA MARIE (OD OPTOMETRIST)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:HILGENDORF
Suffix:
Gender:F
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:ROUINFAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2519 DORA AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4977
Mailing Address - Country:US
Mailing Address - Phone:352-742-8008
Mailing Address - Fax:352-742-8008
Practice Address - Street 1:2519 DORA AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4977
Practice Address - Country:US
Practice Address - Phone:352-742-8008
Practice Address - Fax:352-742-8008
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist