Provider Demographics
NPI:1851330930
Name:RAGOZZINO, STEFANO (OD)
Entity Type:Individual
Prefix:DR
First Name:STEFANO
Middle Name:
Last Name:RAGOZZINO
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 1:17000 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-7281
Mailing Address - Country:US
Mailing Address - Phone:941-525-4771
Mailing Address - Fax:941-497-9833
Practice Address - Street 1:17000 TAMIAMI TRL
Practice Address - Street 2:VISION CENTER
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-7281
Practice Address - Country:US
Practice Address - Phone:941-429-1430
Practice Address - Fax:941-423-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3940152W00000X
CT2568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621195000Medicaid