Provider Demographics
NPI:1053570846
Name:PAUL VISION CARE LLC
Entity type:Organization
Organization Name:PAUL VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-297-1412
Mailing Address - Street 1:85161 SHINNECOCK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8177
Mailing Address - Country:US
Mailing Address - Phone:904-548-0058
Mailing Address - Fax:
Practice Address - Street 1:13227 CITY SQUARE DR
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7218
Practice Address - Country:US
Practice Address - Phone:904-696-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty