Healthcare Provider Details

I. General information

NPI: 1154138725
Provider Name (Legal Business Name): BAILEY JOSHUA STOTLER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 CLARK BUTLER BLVD STE 30
GAINESVILLE FL
32608-2436
US

IV. Provider business mailing address

3807 CALVARY CT
MIDDLEBURG FL
32068-2205
US

V. Phone/Fax

Practice location:
  • Phone: 352-335-1232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: