Provider Demographics
NPI:1205845781
Name:BILLINGS, DENISE FORAN (OD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:FORAN
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:FORAN
Other - Last Name:BILLINGSOD PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2135 TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2123
Mailing Address - Country:US
Mailing Address - Phone:941-624-5772
Mailing Address - Fax:941-624-5730
Practice Address - Street 1:2135 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2123
Practice Address - Country:US
Practice Address - Phone:941-624-5772
Practice Address - Fax:941-624-5730
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410046438OtherRAILRAOD MEDICARE
FL084927800Medicaid
FL084927800Medicaid
T84220Medicare UPIN
T84220Medicare UPIN