Provider Demographics
NPI:1326303264
Name:GALASSO, JOANNA ASHLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:ASHLEY
Last Name:GALASSO
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 1:8211 W BROWARD BLVD PH 2
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2744
Mailing Address - Country:US
Mailing Address - Phone:954-424-3969
Mailing Address - Fax:
Practice Address - Street 1:8211 W BROWARD BLVD PH 2
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2744
Practice Address - Country:US
Practice Address - Phone:954-424-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8013T152W00000X
TX8013TG152W00000X
FLOPC4780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX1124091-04Medicaid