Healthcare Provider Details

I. General information

NPI: 1437276243
Provider Name (Legal Business Name): LAURA MARIE DEMARCO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S POWERLINE RD
POMPANO BEACH FL
33069-4311
US

IV. Provider business mailing address

PO BOX 970543
BOCA RATON FL
33497-0543
US

V. Phone/Fax

Practice location:
  • Phone: 954-977-6636
  • Fax:
Mailing address:
  • Phone: 561-271-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC3552
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3552
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC3552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: