Provider Demographics
NPI:1467659581
Name:VAZQUEZ, JOSE ALFREDO (MD FAAO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALFREDO
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 SE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5699
Mailing Address - Country:US
Mailing Address - Phone:407-733-0194
Mailing Address - Fax:
Practice Address - Street 1:1852 MAYO DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4320
Practice Address - Country:US
Practice Address - Phone:523-432-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135797207W00000X
PR13059207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82229Medicare UPIN