Provider Demographics
NPI:1780710921
Name:MEMOLI, MARIA CHRISTINA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CHRISTINA
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:CHRISTINA
Other - Last Name:MEMOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1420 MCCREA DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3580
Mailing Address - Country:US
Mailing Address - Phone:407-252-8641
Mailing Address - Fax:
Practice Address - Street 1:8220 N DALE MABRY HWY,
Practice Address - Street 2:WALMART OPTICAL
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3361
Practice Address - Country:US
Practice Address - Phone:813-887-4033
Practice Address - Fax:813-654-7748
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407254907Medicaid