Provider Demographics
NPI:1730381708
Name:GARCON, DIMITRI (DO)
Entity type:Individual
Prefix:
First Name:DIMITRI
Middle Name:
Last Name:GARCON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 SHERIDAN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2709
Mailing Address - Country:US
Mailing Address - Phone:754-400-8932
Mailing Address - Fax:954-400-8923
Practice Address - Street 1:7261 SHERIDAN ST STE 305
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2709
Practice Address - Country:US
Practice Address - Phone:754-400-8932
Practice Address - Fax:754-400-8923
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5239156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens