Provider Demographics
NPI:1750425948
Name:PASSARO, VINCENT JR (OD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:PASSARO
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 KEATS DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6599
Mailing Address - Country:US
Mailing Address - Phone:727-534-3726
Mailing Address - Fax:
Practice Address - Street 1:6847 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6032
Practice Address - Country:US
Practice Address - Phone:727-848-2020
Practice Address - Fax:727-847-3937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19573Medicare ID - Type Unspecified
FLU79414Medicare UPIN