Provider Demographics
NPI:1396762951
Name:TOMLINSON, JO ELLEN (OD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-0416
Mailing Address - Country:US
Mailing Address - Phone:850-897-2350
Mailing Address - Fax:
Practice Address - Street 1:1226 FREEPORT HWY S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3396
Practice Address - Country:US
Practice Address - Phone:850-892-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620133400Medicaid
FL20416OtherBCBS
FL20416OtherBCBS
20416VMedicare PIN
20416Medicare PIN