Provider Demographics
NPI:1760442933
Name:PAEY, LINDA S (OD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:PAEY
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 1:7712 CYPRESS KNEE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1433
Mailing Address - Country:US
Mailing Address - Phone:727-863-7232
Mailing Address - Fax:
Practice Address - Street 1:1575 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2930
Practice Address - Country:US
Practice Address - Phone:813-909-0678
Practice Address - Fax:813-909-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU23652Medicare UPIN
FL20724Medicare ID - Type Unspecified