Provider Demographics
NPI:1619091576
Name:PAUL, JOHN STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:PAUL
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 1:198 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-9652
Mailing Address - Country:US
Mailing Address - Phone:561-575-2595
Mailing Address - Fax:561-624-1021
Practice Address - Street 1:3103 PGA BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2801
Practice Address - Country:US
Practice Address - Phone:561-624-1760
Practice Address - Fax:561-624-1021
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU 32356Medicare UPIN