Provider Demographics
NPI:1619667474
Name:PAYTON, JULIA MIGNON (LDO)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MIGNON
Last Name:PAYTON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 RANCH LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3708
Mailing Address - Country:US
Mailing Address - Phone:941-799-5542
Mailing Address - Fax:
Practice Address - Street 1:5810 RANCH LAKE BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3708
Practice Address - Country:US
Practice Address - Phone:941-799-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6511156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician