Provider Demographics
NPI:1306992847
Name:DORADO, GRACE B (OD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:B
Last Name:DORADO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:B
Other - Last Name:DORADO-FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4890 BIG ISLAND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246
Mailing Address - Country:US
Mailing Address - Phone:904-379-1260
Mailing Address - Fax:904-564-2646
Practice Address - Street 1:4890 BIG ISLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:904-379-1260
Practice Address - Fax:904-564-2646
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3465AMedicare UPIN