MEDICARE: TAMPA LIGHTHOUSE FOR THE BLIND INC.

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	OP0001955	FL

General Provider Information

NPI Number	:	1447491709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA LIGHTHOUSE FOR THE BLIND INC.

Provider Business Mailing Address
First Line	:	1106 WEST PLATT STREET
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606
Country	:	US
Telephone Number	:	813-251-2407
Fax Number	:	813-254-4305

Provider Business Practice Location Address
First Line	:	1106 W. PLATT STREET
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606
Country	:	US
Telephone Number	:	813-251-2407
Fax Number	:	813-254-4305

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. CLIFF E. OLSTROM
Credential	:
Telephone Number	:	813-251-2407

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/17/2009

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