Provider Demographics
NPI:1649444332
Name:JO ELLEN TOMLINSON OD LLC
Entity type:Organization
Organization Name:JO ELLEN TOMLINSON OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-892-4022
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:850-892-4022
Mailing Address - Fax:850-892-3975
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:850-892-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20416OtherBCBS
FL620133400Medicaid
FL620133400Medicaid
AK304Medicare PIN