Provider Demographics
NPI:1508120957
Name:TOLUD, CANDICE BERNICE (OD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:BERNICE
Last Name:TOLUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S LENOLA RD STE 11A
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1561
Mailing Address - Country:US
Mailing Address - Phone:856-234-0258
Mailing Address - Fax:856-727-9518
Practice Address - Street 1:509 S LENOLA RD STE 11A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1561
Practice Address - Country:US
Practice Address - Phone:856-234-0258
Practice Address - Fax:856-727-9518
Is Sole Proprietor?:No
Enumeration Date:2012-06-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002714152W00000X
NJ27OM00107400152W00000X
NJ27OA00640200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ244114BK7Medicare PIN