Provider Demographics
NPI:1770540080
Name:GREGAS, ANNE MARIE (OD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GREGAS
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 1:3200 N WICKHAM RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2321
Mailing Address - Country:US
Mailing Address - Phone:321-253-3550
Mailing Address - Fax:
Practice Address - Street 1:3200 N WICKHAM RD STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2321
Practice Address - Country:US
Practice Address - Phone:321-253-3550
Practice Address - Fax:321-253-3591
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620058300Medicaid
FL620058300Medicaid
FL20536Medicare PIN