Provider Demographics
NPI:1104207141
Name:PAUL SOUTHBY, OD, PA
Entity Type:Organization
Organization Name:PAUL SOUTHBY, 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:
Authorized Official - Last Name:SOUTHBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-845-0082
Mailing Address - Street 1:9644 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4653
Mailing Address - Country:US
Mailing Address - Phone:727-845-0082
Mailing Address - Fax:727-344-7952
Practice Address - Street 1:9644 SCENIC DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4653
Practice Address - Country:US
Practice Address - Phone:727-845-0082
Practice Address - Fax:727-344-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty