Provider Demographics
NPI:1518909472
Name:FLORIDIA, MICHAEL J (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:FLORIDIA
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 1:3 CARVER SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1200
Mailing Address - Country:US
Mailing Address - Phone:508-866-2888
Mailing Address - Fax:508-866-5887
Practice Address - Street 1:3 CARVER SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1200
Practice Address - Country:US
Practice Address - Phone:508-866-2888
Practice Address - Fax:508-866-5887
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353744Medicaid
MAW15712OtherBLUE CROSS BLUE SHIELD
MA739608OtherTUFTS HEALTH PLAN
MA15797OtherHARVARD PILGRIM HEALTH
MA15797OtherHARVARD PILGRIM HEALTH
MAW15712OtherBLUE CROSS BLUE SHIELD