Provider Demographics
NPI:1801881354
Name:DEMASI, VERA G (OD)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:G
Last Name:DEMASI
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 1:10703 SW VISCONTI WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2870
Mailing Address - Country:US
Mailing Address - Phone:312-498-9308
Mailing Address - Fax:
Practice Address - Street 1:1750 SW GATLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2777
Practice Address - Country:US
Practice Address - Phone:772-878-1307
Practice Address - Fax:772-878-1309
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007804100Medicaid
221437OtherEYEMED
IL046-009748Medicaid