Provider Demographics
NPI:1578846788
Name:LAUDICINA, PAIGE G (OD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:G
Last Name:LAUDICINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PAIGE
Other - Middle Name:A
Other - Last Name:GILLENWATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2003 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1241
Mailing Address - Country:US
Mailing Address - Phone:941-756-2020
Mailing Address - Fax:941-756-4486
Practice Address - Street 1:2003 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207
Practice Address - Country:US
Practice Address - Phone:941-756-2020
Practice Address - Fax:941-756-4486
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL463216Medicaid
FL463216Medicaid