Provider Demographics
NPI:1437177482
Name:ANASTASI, COSMO J (OD)
Entity Type:Individual
Prefix:DR
First Name:COSMO
Middle Name:J
Last Name:ANASTASI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16313 ASHINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2644
Mailing Address - Country:US
Mailing Address - Phone:813-866-9255
Mailing Address - Fax:813-866-0445
Practice Address - Street 1:38933 COUNTY RD. 54 E.
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2730
Practice Address - Country:US
Practice Address - Phone:813-782-2020
Practice Address - Fax:813-782-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0844781Medicaid
FL0844781Medicaid