Healthcare Provider Details

I. General information

NPI: 1508799883
Provider Name (Legal Business Name): ANTONIA VASSIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTONIA STAVRAKIS

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9644 SCENIC DR
PORT RICHEY FL
34668-4653
US

IV. Provider business mailing address

1623 MOUNTAIN ASH WAY
NEW PORT RICHEY FL
34655-4145
US

V. Phone/Fax

Practice location:
  • Phone: 727-845-0082
  • Fax:
Mailing address:
  • Phone: 727-251-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: