Provider Demographics
NPI:1881027811
Name:PRADILLA, SERGIO (OD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:PRADILLA
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 1:227 BRANDON TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4728
Mailing Address - Country:US
Mailing Address - Phone:813-685-1935
Mailing Address - Fax:
Practice Address - Street 1:227 BRANDON TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4728
Practice Address - Country:US
Practice Address - Phone:813-685-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist