Provider Demographics
NPI:1548406473
Name:JOHN S. GEDDES III OD PA
Entity Type:Organization
Organization Name:JOHN S. GEDDES III OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GEDDES
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:352-360-0306
Mailing Address - Street 1:1508 TEXAS CT
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2130
Mailing Address - Country:US
Mailing Address - Phone:352-360-0306
Mailing Address - Fax:352-693-2449
Practice Address - Street 1:10250 SE 167TH PLACE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8686
Practice Address - Country:US
Practice Address - Phone:352-693-2545
Practice Address - Fax:352-693-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002966600Medicaid
FL002966600Medicaid