Provider Demographics
NPI:1871680637
Name:BAYLY, JULIE P
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:P
Last Name:BAYLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6558
Mailing Address - Country:US
Mailing Address - Phone:407-880-0335
Mailing Address - Fax:407-880-6782
Practice Address - Street 1:730 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6558
Practice Address - Country:US
Practice Address - Phone:407-880-0335
Practice Address - Fax:407-880-6782
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 5279156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630334000Medicaid
FL5540280001Medicare NSC