Provider Demographics
NPI:1962517821
Name:FELICIANO, EMY (OD)
Entity type:Individual
Prefix:DR
First Name:EMY
Middle Name:
Last Name:FELICIANO
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 1:171 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9027
Mailing Address - Country:US
Mailing Address - Phone:407-359-8016
Mailing Address - Fax:407-359-4129
Practice Address - Street 1:171 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9027
Practice Address - Country:US
Practice Address - Phone:407-359-8016
Practice Address - Fax:407-359-4129
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620946701Medicaid