Provider Demographics
NPI:1740662014
Name:PETRESCU PETERSEN, VIORICA ANDRONACHE
Entity type:Individual
Prefix:
First Name:VIORICA
Middle Name:ANDRONACHE
Last Name:PETRESCU PETERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S OCEAN DR
Mailing Address - Street 2:SUITE G-9
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2927
Mailing Address - Country:US
Mailing Address - Phone:954-456-3808
Mailing Address - Fax:954-454-1012
Practice Address - Street 1:3800 S OCEAN DR
Practice Address - Street 2:SUITE G-9
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2927
Practice Address - Country:US
Practice Address - Phone:954-456-3808
Practice Address - Fax:954-454-1012
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FC0801X
FLDO5803156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician