MEDICARE: KURT THEODORE OD PA

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	OPC2398	FL

General Provider Information

NPI Number	:	1609998814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURT THEODORE OD PA

Provider Business Mailing Address
First Line	:	2747 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3945
Country	:	US
Telephone Number	:	727-431-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 TAMPA RD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3008
Country	:	US
Telephone Number	:	813-852-2030
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KURT THEODORE
Credential	:	O.D.
Telephone Number	:	813-852-2030

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/09/2022

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