MEDICARE: DR. PAUL G. MIDDLETON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	05259T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05259T	OTHER	TX	TEXAS OPTOMETRY BOARD

General Provider Information

NPI Number	:	1578709762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL G. MIDDLETON OD

Provider Business Mailing Address
First Line	:	2210 SAN JACINTO BLVD
Second Line	:	SUITE 1
City	:	DENTON
State	:	TX
Zip	:	76205-7527
Country	:	US
Telephone Number	:	940-382-8000
Fax Number	:	940-383-2608

Provider Business Practice Location Address
First Line	:	2210 SAN JACINTO BLVD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7527
Country	:	US
Telephone Number	:	940-382-8000
Fax Number	:	940-383-2608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	01/20/2012

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