Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC2378 | FL |
NPI | 1003952268 |
---|---|
Provider Name | Dr. David Lee Middaugh |
First Address | Spring Hill, FL 34609-3041 |
Second Address | Spring Hill, FL 34606-2330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078970400 | (05) | FL |
T14813 | (02) | FL |