Provider Demographics
NPI:1730412164
Name:LONDONO, JEANETTE (OD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:LONDONO
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 1:17895 SE 107TH TER
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8400
Mailing Address - Country:US
Mailing Address - Phone:352-347-1357
Mailing Address - Fax:
Practice Address - Street 1:4200 CONROY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2400
Practice Address - Country:US
Practice Address - Phone:407-903-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist