Provider Demographics
NPI:1043395395
Name:PADOVAN, VALDECIR (OD)
Entity Type:Individual
Prefix:
First Name:VALDECIR
Middle Name:
Last Name:PADOVAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5880
Mailing Address - Country:US
Mailing Address - Phone:330-697-4748
Mailing Address - Fax:866-425-2239
Practice Address - Street 1:3265 W. MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-3337
Practice Address - Country:US
Practice Address - Phone:330-697-4748
Practice Address - Fax:866-425-2239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU69203Medicare UPIN