Judy L Deitrick, OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

2024 Issued in FL

Practice address

2631 Dunn Ave
Jacksonville, FL 32218-4656

Phone

(904) 765-3611

Fax

(904) 765-4256

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Judy L Deitrick Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sight N Style Optical Inc

  • Eyewear Supplier
  • Jacksonville, FL
  • NPI 1649057621
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217894400000",
    "number": "1700933215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631-3 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184693",
            "telephone_number": "904-765-3611",
            "fax_number": "904-765-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184656",
            "telephone_number": "904-765-3611",
            "fax_number": "904-765-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITRICK",
        "first_name": "JUDY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "2024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDY",
            "last_name": "DEITRICK",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "OPTICIAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Alysha Marina Degrove, DNP
• Joshua Phillip Dehart, MD
• Mary Elizabeth Dehay, ARNP
• Savanna Dehner
• Amy Lee Deichert, MS-SP-CCC
• Elizabeth Dejesus, PTA
• Mayra Dejesus, ARNP
• Bryana Dejoie
• Amber Renee Dekoschak, MD
• Maria Giselda Del Busto-Carames, PH.D.

• Optician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.