Provider Demographics
NPI:1801419676
Name:TOLEDO, MICHELLE M (LDO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:TOLEDO
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 1:7631 HORSE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-9021
Mailing Address - Country:US
Mailing Address - Phone:352-796-0340
Mailing Address - Fax:352-777-4917
Practice Address - Street 1:7631 HORSE LAKE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-9021
Practice Address - Country:US
Practice Address - Phone:352-796-0340
Practice Address - Fax:352-777-4917
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7130156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician