Provider Demographics
NPI:1538350715
Name:ANANDAN, VASUKI (OD)
Entity type:Individual
Prefix:DR
First Name:VASUKI
Middle Name:
Last Name:ANANDAN
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 1:702 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2617
Mailing Address - Country:US
Mailing Address - Phone:804-616-2655
Mailing Address - Fax:
Practice Address - Street 1:702 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2617
Practice Address - Country:US
Practice Address - Phone:804-616-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00610500152W00000X
VA0618001997152W00000X
FLOPC6544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist