Provider Demographics
NPI:1023692431
Name:PASCUAL, JOHNNY ADRIAN (OD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:ADRIAN
Last Name:PASCUAL
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 1:4954 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1413
Mailing Address - Country:US
Mailing Address - Phone:850-910-4840
Mailing Address - Fax:
Practice Address - Street 1:4954 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1413
Practice Address - Country:US
Practice Address - Phone:850-910-4840
Practice Address - Fax:850-254-2970
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT-250-TA-C15152W00000X
FLOPC6077152W00000X
CA35035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist