Provider Demographics
NPI:1982836151
Name:LING, DEDRA NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DEDRA
Middle Name:NICOLE
Last Name:LING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 4TH ST
Mailing Address - Street 2:APT #1
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3739
Mailing Address - Country:US
Mailing Address - Phone:708-351-5701
Mailing Address - Fax:
Practice Address - Street 1:1444 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4008
Practice Address - Country:US
Practice Address - Phone:708-351-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC004474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist