Provider Demographics
NPI:1588870505
Name:FORREST, DEBBIE SHEILA (OD)
Entity type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:SHEILA
Last Name:FORREST
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 1:4200 CONROY RD
Mailing Address - Street 2:SPACE L-201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2400
Mailing Address - Country:US
Mailing Address - Phone:407-903-1018
Mailing Address - Fax:407-903-1066
Practice Address - Street 1:4200 CONROY RD
Practice Address - Street 2:SPACE L-201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2400
Practice Address - Country:US
Practice Address - Phone:407-903-1018
Practice Address - Fax:407-903-1066
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2961152WC0802X, 152W00000X
FLOPC 2961152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620190300Medicaid
FLOPC 2961OtherFLORIDA LICENSE NUMBER
AZ1349OtherARIZONA LICENSE NUMBER
FL20802YMedicare ID - Type UnspecifiedMEDICARE NUMBER