Provider Demographics
NPI:1376502765
Name:SOUTHBY, PAUL ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALEXANDER
Last Name:SOUTHBY
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 1:9644 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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist