Provider Demographics
NPI:1003952268
Name:MIDDAUGH, DAVID LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:MIDDAUGH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14089 CANDIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-3041
Mailing Address - Country:US
Mailing Address - Phone:352-683-5968
Mailing Address - Fax:352-688-9426
Practice Address - Street 1:7235 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2330
Practice Address - Country:US
Practice Address - Phone:352-686-5614
Practice Address - Fax:352-688-9426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078970400Medicaid
FL20294Medicare ID - Type Unspecified
FLT14813Medicare UPIN