Provider Demographics
NPI:1952339921
Name:GEDDES, JOHN S III (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:GEDDES
Suffix:III
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 1:1508 TEXAS CT
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2130
Mailing Address - Country:US
Mailing Address - Phone:352-360-0306
Mailing Address - Fax:
Practice Address - Street 1:10250 SE 167TH PLACE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8686
Practice Address - Country:US
Practice Address - Phone:352-693-2545
Practice Address - Fax:352-693-2449
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620130000Medicaid
FL620130000Medicaid