Provider Demographics
NPI:1154358893
Name:EARL, DEAN W (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:W
Last Name:EARL
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6219
Mailing Address - Country:US
Mailing Address - Phone:772-569-4822
Mailing Address - Fax:772-770-3484
Practice Address - Street 1:715 17TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6219
Practice Address - Country:US
Practice Address - Phone:772-569-4822
Practice Address - Fax:772-770-3484
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1858156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0824980001Medicare ID - Type UnspecifiedPROVIDER NUMBER