Provider Demographics
NPI:1306013669
Name:WEBB, PAUL EVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EVAN
Last Name:WEBB
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 1:2080 CHILD STREET
Mailing Address - Street 2:OPTOMETRY CLINIC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212
Mailing Address - Country:US
Mailing Address - Phone:904-546-7129
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD STREET
Practice Address - Street 2:OPTOMETRY CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212
Practice Address - Country:US
Practice Address - Phone:904-546-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist