Provider Demographics
NPI:1093016560
Name:PAUL A. BREAULT OD, PA
Entity Type:Organization
Organization Name:PAUL A. BREAULT OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-957-3319
Mailing Address - Street 1:891 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7824
Mailing Address - Country:US
Mailing Address - Phone:941-957-3319
Mailing Address - Fax:
Practice Address - Street 1:891 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7824
Practice Address - Country:US
Practice Address - Phone:941-957-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty