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NPI Code Detail

MEDICARE: DEAN N SHISSIAS O.D.

MEDICARE: DEAN N SHISSIAS O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOA04264NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770584625
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAN N SHISSIAS O.D.
Provider Business Mailing Address
First Line : 9701 VENTNOR AVE
Second Line :
City : MARGATE CITY
State : NJ
Zip : 08402-2222
Country : US
Telephone Number : 609-399-6102
Fax Number : 609-399-4424
Provider Business Practice Location Address
First Line : 9701 VENTNOR AVE
Second Line :
City : MARGATE CITY
State : NJ
Zip : 08402-2222
Country : US
Telephone Number : 609-822-4242
Fax Number : 609-822-3211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 12/20/2018

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Directions to “ DEAN N SHISSIAS O.D.” Practice Location

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