Provider Demographics
NPI:1679715791
Name:SARRIS, PANAGIOTIS (LDO)
Entity type:Individual
Prefix:MR
First Name:PANAGIOTIS
Middle Name:
Last Name:SARRIS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1620
Mailing Address - Country:US
Mailing Address - Phone:954-567-4488
Mailing Address - Fax:954-567-4445
Practice Address - Street 1:2501 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-1620
Practice Address - Country:US
Practice Address - Phone:954-567-4488
Practice Address - Fax:954-567-4445
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3909156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician