Provider Demographics
NPI:1174578454
Name:RAGOZZINO, AMY SUZANNE (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUZANNE
Last Name:RAGOZZINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4150 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5130
Mailing Address - Country:US
Mailing Address - Phone:941-497-5555
Mailing Address - Fax:941-497-2369
Practice Address - Street 1:4150 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5130
Practice Address - Country:US
Practice Address - Phone:941-497-5555
Practice Address - Fax:941-497-2369
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41542OtherSPECTERA PROVIDER NUMBER
FLOPC 4087OtherSTATE LICENSE NUMBER
CT2606OtherSTATE LICENSE NUMBER
FLOPC 4087OtherSTATE LICENSE NUMBER
FL41542OtherSPECTERA PROVIDER NUMBER