Provider Demographics
NPI:1417944364
Name:SOTO JR, FREDERICK E (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:E
Last Name:SOTO JR
Suffix:
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 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-488-2020
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:2650 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4503
Practice Address - Country:US
Practice Address - Phone:941-953-3111
Practice Address - Fax:941-366-5670
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078090100Medicaid
FLT84115Medicare UPIN
FL0495470001Medicare NSC
FL19202Medicare ID - Type Unspecified