Provider Demographics
NPI:1730789256
Name:MUNIZ, FANNY MARITZA (OD)
Entity type:Individual
Prefix:
First Name:FANNY
Middle Name:MARITZA
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:FANNY
Other - Middle Name:MARITZA
Other - Last Name:GUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13217 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6807
Mailing Address - Country:US
Mailing Address - Phone:352-597-1209
Mailing Address - Fax:877-210-5491
Practice Address - Street 1:13217 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6807
Practice Address - Country:US
Practice Address - Phone:352-597-1209
Practice Address - Fax:877-210-5491
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist