Provider Demographics
NPI:1508348012
Name:VILLANTI, DOMINIC (OD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:VILLANTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E ATLANTIC AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-4535
Mailing Address - Country:US
Mailing Address - Phone:612-795-4444
Mailing Address - Fax:
Practice Address - Street 1:302 E ATLANTIC AVE STE 1B
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-4535
Practice Address - Country:US
Practice Address - Phone:561-279-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist