Most Relevant Information
Provider Data
| NPI Number: | 1003243502 |
| Provider Name: | ROMANDA BASALY DEMETRIOS O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | 4901004806 |
Most Important Dates
| Enumeration Date: | 09/30/2013 |
| Last Updated: | 07/19/2022 |
Provider Practice Location
155 FOUNTAINS WAY STE 11
SAINT JOHNS
FL
322591144
Practice Location Phone/Fax
| Phone: | 4049322802 |
| Fax: |
Provider Mailing Location
133 RUM RUNNER WAY
SAINT JOHNS
FL
322592267
Provider Mailing Phone/Fax
| Phone: | 4049322802 |
| Fax: |