Provider Demographics
NPI:1932192853
Name:DESROSIERS, JOYCE E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:E
Last Name:DESROSIERS
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 1:634 21ST ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0933
Mailing Address - Country:US
Mailing Address - Phone:772-567-6513
Mailing Address - Fax:772-567-6993
Practice Address - Street 1:634 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0933
Practice Address - Country:US
Practice Address - Phone:772-567-6513
Practice Address - Fax:772-567-6993
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1740455526OtherDMERC
FL7607417OtherAETNA
FL043636759OtherVISION SERVICE PLAN
FL1740455526OtherJURISDICTION C
FL1740455526OtherDME MAC JURISDICTION C
FL410047447OtherRAILROAD MEDICARE
FL1932192853OtherMEDICARE NPI
FL620690500Medicaid
FL1932192853OtherNPI
FL19865OtherBLUE CROSS BLUE SHIELD
FL7607417OtherAETNA
FL1740455526OtherJURISDICTION C
FL1932192853OtherMEDICARE NPI
FL4457280001Medicare NSC