Provider Demographics
NPI:1043978281
Name:GRACE B DORADO-FOSTER DOCTOR OF OPTOMETRY PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:GRACE B DORADO-FOSTER DOCTOR OF OPTOMETRY PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-379-1260
Mailing Address - Street 1:4890 BIG ISLAND DR STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7490
Mailing Address - Country:US
Mailing Address - Phone:904-379-1260
Mailing Address - Fax:904-564-2646
Practice Address - Street 1:4890 BIG ISLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7490
Practice Address - Country:US
Practice Address - Phone:904-379-1260
Practice Address - Fax:904-564-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty