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General NPI Number Information
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NPI Number | 1619083219
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Entity Type | Individual
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Provider Name | PETER ANTHONY SANTISI OD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 950 N COURTENAY PKWY SUITE 12
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4501
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Country | US
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Telephone | 321-453-1657
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Fax | 321-453-1659
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Provider Business Mailing Address
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Address Line | 1075 NEW HAMPTON WAY
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3215
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Country | US
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Telephone | 321-452-9768
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Fax | 321-452-9768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4171
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License Number State | FL
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