1366112401 NPI number — RAYMOND FOREHAND OD AND ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366112401 NPI number — RAYMOND FOREHAND OD AND ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYMOND FOREHAND OD AND ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366112401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13205 REAMS RD UNIT 152
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDERMERE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34786-9543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-258-3222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13205 REAMS ROAD
Provider Second Line Business Practice Location Address:
UNIT 152
Provider Business Practice Location Address City Name:
WINDMERE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34756-9543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-258-3222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FOREHAND
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
904-556-1610

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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