Provider Demographics
NPI:1811005036
Name:O'HORA, JANE BUCCI (OD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:BUCCI
Last Name:O'HORA
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 1:922 COUGAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-8705
Mailing Address - Country:US
Mailing Address - Phone:401-374-7486
Mailing Address - Fax:863-385-3940
Practice Address - Street 1:4325 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2171
Practice Address - Country:US
Practice Address - Phone:863-385-3937
Practice Address - Fax:863-385-3940
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7022ZMedicare PIN
FLU98142Medicare UPIN