Provider Demographics
NPI:1114192747
Name:FREDERICK E. SOTO, JR., O.D., P.A.
Entity Type:Organization
Organization Name:FREDERICK E. SOTO, JR., O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:941-953-3111
Mailing Address - Street 1:2650 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4531
Mailing Address - Country:US
Mailing Address - Phone:941-953-3111
Mailing Address - Fax:941-366-5670
Practice Address - Street 1:2650 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4531
Practice Address - Country:US
Practice Address - Phone:941-953-3111
Practice Address - Fax:941-366-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-001562332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
T84115OtherCIGNA HEALTHCARE OF FLORIDA
FL0495470001OtherCIGNA GOVERNMENT SERVICES
FL0495470001OtherCIGNA GOVERNMENT SERVICES