Healthcare Provider Details

I. General information

NPI: 1114192747
Provider Name (Legal Business Name): FREDERICK E. SOTO, JR., O.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 S TAMIAMI TRL
SARASOTA FL
34239-4531
US

IV. Provider business mailing address

2650 S TAMIAMI TRL
SARASOTA FL
34239-4531
US

V. Phone/Fax

Practice location:
  • Phone: 941-953-3111
  • Fax: 941-366-5670
Mailing address:
  • Phone: 941-953-3111
  • Fax: 941-366-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOPC-001562
License Number StateFL

VIII. Authorized Official

Name: DR. FREDERICK E SOTO JR.
Title or Position: PRESIDENT
Credential: O.D.
Phone: 941-953-3111