Provider Demographics
NPI:1023702123
Name:PADUA, FLORENCE MAE DE VERA (OD)
Entity type:Individual
Prefix:DR
First Name:FLORENCE MAE
Middle Name:DE VERA
Last Name:PADUA
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 1:1848 ROCK LAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-5817
Mailing Address - Country:US
Mailing Address - Phone:757-646-6301
Mailing Address - Fax:
Practice Address - Street 1:701 LYNNHAVEN PKWY SPC B2
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7299
Practice Address - Country:US
Practice Address - Phone:757-431-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist