Healthcare Provider Details

I. General information

NPI: 1518909472
Provider Name (Legal Business Name): MICHAEL J FLORIDIA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CARVER SQUARE BLVD
CARVER MA
02330-1200
US

IV. Provider business mailing address

3 CARVER SQUARE BLVD
CARVER MA
02330-1200
US

V. Phone/Fax

Practice location:
  • Phone: 508-866-2888
  • Fax: 508-866-5887
Mailing address:
  • Phone: 508-866-2888
  • Fax: 508-866-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: