Provider Demographics
NPI:1063573574
Name:ASSOCIATED OPTOMETRISTS OF OVERHOLSER & OVERHOLSER OD PA
Entity type:Organization
Organization Name:ASSOCIATED OPTOMETRISTS OF OVERHOLSER & OVERHOLSER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:OVERHOLSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-875-1173
Mailing Address - Street 1:21455 NW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:MICANOPY
Mailing Address - State:FL
Mailing Address - Zip Code:32667
Mailing Address - Country:US
Mailing Address - Phone:352-875-1173
Mailing Address - Fax:352-237-9479
Practice Address - Street 1:17961 S HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-307-4435
Practice Address - Fax:352-307-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45326OtherBCBS OF FL
FL45326OtherBCBS OF FL
FL45326OtherBCBS OF FL