Provider Demographics
NPI:1740271519
Name:BIRR, JANICE I (OD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:I
Last Name:BIRR
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 1:4120 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7165
Mailing Address - Country:US
Mailing Address - Phone:239-542-2020
Mailing Address - Fax:239-541-1492
Practice Address - Street 1:4120 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7165
Practice Address - Country:US
Practice Address - Phone:239-542-2020
Practice Address - Fax:239-541-1492
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078876700Medicaid
FLT77507Medicare UPIN
FL078876700Medicaid