Provider Demographics
NPI:1265711543
Name:SAUNDERS, DENISE DIANE (OD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:DIANE
Last Name:SAUNDERS
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 1:1131 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-1603
Mailing Address - Country:US
Mailing Address - Phone:347-886-4438
Mailing Address - Fax:
Practice Address - Street 1:1169 POSNER BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3664
Practice Address - Country:US
Practice Address - Phone:347-886-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007761152W00000X
GAOPT002716152W00000X
FLOPC5043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03565639Medicaid
NYA300076640OtherMEDICARE PTAN