Provider Demographics
NPI:1386093193
Name:LOUISSAINT, VANESSA (OD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LOUISSAINT
Suffix:
Gender:F
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:P.O. BOX 641291
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33164-1291
Mailing Address - Country:US
Mailing Address - Phone:305-213-8031
Mailing Address - Fax:
Practice Address - Street 1:10047 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-5303
Practice Address - Country:US
Practice Address - Phone:954-749-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist