Provider Demographics
NPI:1245266428
Name:PAUL, ADELE DEBRA (OD)
Entity type:Individual
Prefix:DR
First Name:ADELE
Middle Name:DEBRA
Last Name:PAUL
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 1:13227 CITY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7218
Mailing Address - Country:US
Mailing Address - Phone:904-696-1433
Mailing Address - Fax:904-751-5807
Practice Address - Street 1:13227 CITY SQUARE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7218
Practice Address - Country:US
Practice Address - Phone:904-696-1433
Practice Address - Fax:904-751-5807
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650126036OtherVSP
FL086912100Medicaid
FL20239OtherBLUE CROSS BLUE SHIELD
FL20239AMedicare ID - Type Unspecified