Provider Demographics
NPI:1861608481
Name:DOMINGUEZ, VYMARYS J (OD)
Entity type:Individual
Prefix:DR
First Name:VYMARYS
Middle Name:J
Last Name:DOMINGUEZ
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 1:10009 LAKE DISTRICT LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5831
Mailing Address - Country:US
Mailing Address - Phone:407-323-1111
Mailing Address - Fax:
Practice Address - Street 1:3653 S ORLANDO DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5611
Practice Address - Country:US
Practice Address - Phone:407-323-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003227152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management