Provider Demographics
NPI:1174584056
Name:PARISE, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:PARISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:DUNG
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S AUSTRALIAN AVE
Mailing Address - Street 2:UNIT 425
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5083
Mailing Address - Country:US
Mailing Address - Phone:561-373-3049
Mailing Address - Fax:
Practice Address - Street 1:318 E PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5016
Practice Address - Country:US
Practice Address - Phone:561-338-0081
Practice Address - Fax:561-338-8291
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4682ZMedicare PIN
V04922Medicare UPIN