1366557639 NPI number — DR. ALAN O MARAMARA OD

Table of content: DR. ALAN O MARAMARA OD (NPI 1366557639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366557639 NPI number — DR. ALAN O MARAMARA OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARAMARA
Provider First Name:
ALAN
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366557639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WEST COAST MOBILE EYE CARE
Provider Second Line Business Mailing Address:
P. O. BOX 39
Provider Business Mailing Address City Name:
RUSKIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33575-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-886-2020
Provider Business Mailing Address Fax Number:
813-886-7222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 COLLEGE AVE. W
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
RUSKIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33570-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-886-2020
Provider Business Practice Location Address Fax Number:
813-886-7222
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC2476 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20252V . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 084867100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104819900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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