Provider Demographics
NPI:1912195785
Name:PETER A SANTISI OD PL
Entity Type:Organization
Organization Name:PETER A SANTISI OD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTISI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-453-1657
Mailing Address - Street 1:1075 NEW HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3215
Mailing Address - Country:US
Mailing Address - Phone:321-720-4572
Mailing Address - Fax:
Practice Address - Street 1:950 N COURTENAY PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4501
Practice Address - Country:US
Practice Address - Phone:321-453-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4171261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDR8010OtherMEDICARE RAILROAD
FLDR8010OtherMEDICARE RAILROAD