Provider Demographics
NPI:1407254907
Name:M CHRISTINA MEMOLI OD PA
Entity Type:Organization
Organization Name:M CHRISTINA MEMOLI OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:MEMOLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-252-8641
Mailing Address - Street 1:8001 S ORANGE BLOSSOM TRL STE 700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-9129
Mailing Address - Country:US
Mailing Address - Phone:407-855-5321
Mailing Address - Fax:407-855-5340
Practice Address - Street 1:27901 US 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-725-0708
Practice Address - Fax:813-316-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty