Provider Demographics
NPI:1497519615
Name:PADGETT, CECILIA (LDO)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:PADGETT
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:A
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LDO
Mailing Address - Street 1:3767 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3528
Mailing Address - Country:US
Mailing Address - Phone:850-934-6419
Mailing Address - Fax:850-934-7499
Practice Address - Street 1:3767 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3528
Practice Address - Country:US
Practice Address - Phone:850-934-6419
Practice Address - Fax:850-934-7499
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5732156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician