Provider Demographics
NPI:1326233685
Name:MARINO, VANESSA C (OD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:C
Last Name:MARINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 SW 124TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5847
Mailing Address - Country:US
Mailing Address - Phone:305-233-2040
Mailing Address - Fax:305-233-2052
Practice Address - Street 1:8353 SW 124TH ST STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5847
Practice Address - Country:US
Practice Address - Phone:305-233-2040
Practice Address - Fax:305-233-2052
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist