Provider Demographics
NPI:1801419007
Name:KARUNATHILAKE, NIRMANI PUMIKA (OD)
Entity Type:Individual
Prefix:MISS
First Name:NIRMANI
Middle Name:PUMIKA
Last Name:KARUNATHILAKE
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 1:3642 GRECKO DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5200
Mailing Address - Country:US
Mailing Address - Phone:813-464-4596
Mailing Address - Fax:
Practice Address - Street 1:5533 SW 64TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9608
Practice Address - Country:US
Practice Address - Phone:352-271-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5788152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation