Provider Demographics
NPI:1730660846
Name:DENINIS, VINCENT MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MICHAEL
Last Name:DENINIS
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 1:11 PARKLANDS DR UNIT 638
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5196
Mailing Address - Country:US
Mailing Address - Phone:607-727-0007
Mailing Address - Fax:
Practice Address - Street 1:10 WILLIAM POPE DR STE 6
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7550
Practice Address - Country:US
Practice Address - Phone:843-705-1524
Practice Address - Fax:843-705-1524
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT.2222152W00000X
NYTUV008863-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist