Provider Demographics
NPI:1922331735
Name:VILLALONGA, HAISEL (OD)
Entity type:Individual
Prefix:DR
First Name:HAISEL
Middle Name:
Last Name:VILLALONGA
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 1:1801 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5026
Mailing Address - Country:US
Mailing Address - Phone:786-285-4463
Mailing Address - Fax:
Practice Address - Street 1:1801 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5026
Practice Address - Country:US
Practice Address - Phone:786-285-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4441152W00000X
FLOPC4441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001230400Medicaid
FL8740OtherICARE
FLCJ1452Medicare Oscar/Certification