Provider Demographics
NPI:1548276751
Name:CAPPELLI, RENA (OD)
Entity type:Individual
Prefix:DR
First Name:RENA
Middle Name:
Last Name:CAPPELLI
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 1:1536 N JEFFERSON ST
Mailing Address - Street 2:JOPC EYE CLINIC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6525
Mailing Address - Country:US
Mailing Address - Phone:904-475-6310
Mailing Address - Fax:904-232-2381
Practice Address - Street 1:1536 N JEFFERSON ST
Practice Address - Street 2:JOPC EYE CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6525
Practice Address - Country:US
Practice Address - Phone:904-475-6310
Practice Address - Fax:904-232-2381
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA781732847AMedicaid
FL6209106-00Medicaid
GA781732847AMedicaid
FLU3498YMedicare PIN
FL6209106-00Medicaid