Provider Demographics
NPI:1578738159
Name:DASSLER, JUDY CHIFEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:CHIFEN
Last Name:DASSLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9543 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2501
Mailing Address - Country:US
Mailing Address - Phone:305-866-7247
Mailing Address - Fax:305-866-4005
Practice Address - Street 1:9543 HARDING AVE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-2501
Practice Address - Country:US
Practice Address - Phone:305-866-7247
Practice Address - Fax:305-866-4005
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0003322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621214000Medicaid