MEDICARE: BEYOND 2020 VISION SPECIALISTS ODESSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1366275133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND 2020 VISION SPECIALISTS ODESSA

Provider Business Mailing Address
First Line	:	16230 HWY 54
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3729
Country	:	US
Telephone Number	:	813-926-5993
Fax Number	:

Provider Business Practice Location Address
First Line	:	16230 HWY 54
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3729
Country	:	US
Telephone Number	:	813-926-5993
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER TUMOLO
Credential	:	OD
Telephone Number	:	813-926-5993

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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