MEDICARE: BRITTON PLAZA VISION CENTER

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	156FX1800X	Optician	DO5003	FL

General Provider Information

NPI Number	:	1447316146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITTON PLAZA VISION CENTER

Provider Business Mailing Address
First Line	:	3802 BRITTON PLZ # A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1406
Country	:	US
Telephone Number	:	813-837-0077
Fax Number	:	813-839-8509

Provider Business Practice Location Address
First Line	:	3802 BRITTON PLZ # A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1406
Country	:	US
Telephone Number	:	813-837-0077
Fax Number	:	813-839-8509

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SUE RENFROE
Credential	:	L.D.O.
Telephone Number	:	813-837-0077

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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