Provider Demographics
NPI:1770856239
Name:NICOLE CREMATA OD PA
Entity Type:Organization
Organization Name:NICOLE CREMATA OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CREMATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-296-5020
Mailing Address - Street 1:3202 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4114
Mailing Address - Country:US
Mailing Address - Phone:305-296-5020
Mailing Address - Fax:
Practice Address - Street 1:3202 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4114
Practice Address - Country:US
Practice Address - Phone:305-296-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty