Provider Demographics
NPI:1194885632
Name:JOEL MARANTZ, OD,PA
Entity type:Organization
Organization Name:JOEL MARANTZ, OD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-898-3155
Mailing Address - Street 1:929 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1501
Mailing Address - Country:US
Mailing Address - Phone:727-898-3155
Mailing Address - Fax:727-821-1912
Practice Address - Street 1:929 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1501
Practice Address - Country:US
Practice Address - Phone:727-898-3155
Practice Address - Fax:727-821-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC000831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1103Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FL0432020001Medicare NSC