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Individual

DR. PAUL A. BREAULT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1647 SUN CITY CENTER PLZ STE 103, SUN CITY CENTER, FL 33573-5374
(813) 634-6344
Mailing address
1647 SUN CITY CENTER PLZ STE 103, SUN CITY CENTER, FL 33573-5374
(813) 634-6344

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC3216
FL
152WC0802X
Corneal and Contact Management Optometrist
Primary
OPC 3216
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
59-3632508
TAX-ID #
FL
Enumeration date
07/10/2006
Last updated
11/12/2020
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