Provider Demographics
NPI:1255011623
Name:PAPAN, ALISSA (OD)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:PAPAN
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 1:7691 SIMMS ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2643
Mailing Address - Country:US
Mailing Address - Phone:754-246-2741
Mailing Address - Fax:
Practice Address - Street 1:8128 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2012
Practice Address - Country:US
Practice Address - Phone:954-475-1611
Practice Address - Fax:954-475-7704
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist