Provider Demographics
NPI:1366557639
Name:MARAMARA, ALAN O (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:O
Last Name:MARAMARA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST COAST MOBILE EYE CARE
Mailing Address - Street 2:P. O. BOX 39
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-0039
Mailing Address - Country:US
Mailing Address - Phone:813-886-2020
Mailing Address - Fax:813-886-7222
Practice Address - Street 1:25 COLLEGE AVE. W
Practice Address - Street 2:STE D
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4701
Practice Address - Country:US
Practice Address - Phone:813-886-2020
Practice Address - Fax:813-886-7222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20252VOtherMEDICARE
FL084867100Medicaid
FL20252VOtherMEDICARE
FL20252AMedicare ID - Type Unspecified