Provider Demographics
NPI:1679534911
Name:OCASIO, JOHN A (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:OCASIO
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 1:627 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3880
Mailing Address - Country:US
Mailing Address - Phone:813-385-6366
Mailing Address - Fax:
Practice Address - Street 1:227-B BRANDON TOWNE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-685-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4088152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6622AMedicare ID - Type Unspecified
FLV07790Medicare UPIN