Provider Demographics
NPI:1679756043
Name:KURTZ, SHARON MARIE (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MARIE
Last Name:KURTZ
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 S ORANGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2921
Mailing Address - Country:US
Mailing Address - Phone:407-422-6798
Mailing Address - Fax:407-843-5215
Practice Address - Street 1:1622 S ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2921
Practice Address - Country:US
Practice Address - Phone:407-422-6798
Practice Address - Fax:407-843-5215
Is Sole Proprietor?:No
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4602156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician