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General NPI Number Information
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NPI Number | 1518135649
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Entity Type | Organization
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Legal Business Name | PAUL B. MOLL, O.D. LLC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 828 S US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34950-5126
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Country | US
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Telephone | 772-466-2070
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Fax |
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Provider Business Mailing Address
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Address Line | 828 S US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34950-5126
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Country | US
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Telephone | 772-466-2070
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. PAUL BRADLEY MOLL
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Credential | O.D.
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Telephone | 772-466-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 2908
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License Number State | FL
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