Provider Demographics
NPI:1568668622
Name:MOCANU, MIHAI (OD)
Entity Type:Individual
Prefix:
First Name:MIHAI
Middle Name:
Last Name:MOCANU
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 1:6518 BURNHAM CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2505
Mailing Address - Country:US
Mailing Address - Phone:860-508-7288
Mailing Address - Fax:
Practice Address - Street 1:1450 BOWENS MILL RD SE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-1500
Practice Address - Country:US
Practice Address - Phone:912-384-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCFJNMedicare ID - Type Unspecified
U63085Medicare UPIN