Provider Demographics
NPI:1174214423
Name:WALDROP, PAUL BRADLEY (LDO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRADLEY
Last Name:WALDROP
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17961 S US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8685
Mailing Address - Country:US
Mailing Address - Phone:352-307-4435
Mailing Address - Fax:352-307-4437
Practice Address - Street 1:17961 S US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8685
Practice Address - Country:US
Practice Address - Phone:352-307-4435
Practice Address - Fax:352-307-4437
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5790156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician