Healthcare Provider Details

I. General information

NPI: 1164749297
Provider Name (Legal Business Name): ALETHIA HELEN PANTAZIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 SE LAUREL RUN DR
OCALA FL
34471-8205
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 522-090-3003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39389
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.124959
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberME114070
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME 114070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: