Provider Demographics
NPI:1619083219
Name:SANTISI, PETER ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:SANTISI
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 1:1075 NEW HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3215
Mailing Address - Country:US
Mailing Address - Phone:321-452-9768
Mailing Address - Fax:321-452-9768
Practice Address - Street 1:950 N COURTENAY PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4501
Practice Address - Country:US
Practice Address - Phone:321-453-1657
Practice Address - Fax:321-453-1659
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00967051OtherMEDICARE RAILROAD
FL002931400Medicaid
FLP00967051OtherMEDICARE RAILROAD