Provider Demographics
NPI:1003968751
Name:GRAMANZINI, MASSIMO R (OD)
Entity Type:Individual
Prefix:DR
First Name:MASSIMO
Middle Name:R
Last Name:GRAMANZINI
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 1:12220 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2233
Mailing Address - Country:US
Mailing Address - Phone:954-423-8444
Mailing Address - Fax:
Practice Address - Street 1:12220 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-2233
Practice Address - Country:US
Practice Address - Phone:954-423-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3116152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69523Medicare UPIN
FL20795Medicare ID - Type Unspecified
20795Medicare PIN