Provider Demographics
NPI:1922331735
Name:VILLALONGA, HAISEL (OD)
Entity Type:Individual
Prefix:DR
First Name:HAISEL
Middle Name:
Last Name:VILLALONGA
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 1:1801 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5026
Mailing Address - Country:US
Mailing Address - Phone:786-285-4463
Mailing Address - Fax:
Practice Address - Street 1:6233 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4022
Practice Address - Country:US
Practice Address - Phone:954-721-0000
Practice Address - Fax:954-721-6308
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4441152W00000X
FLOPC 4441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001230400Medicaid
FL8740OtherICARE
FLCJ1452Medicare Oscar/Certification