Healthcare Provider Details

I. General information

NPI: 1689773657
Provider Name (Legal Business Name): EYE SITE OF TAMPA BAY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 GULF TO BAY BLVD SUITE 100
CLEARWATER FL
33765-4413
US

IV. Provider business mailing address

2560 GULF TO BAY BLVD SUITE 100
CLEARWATER FL
33765-4413
US

V. Phone/Fax

Practice location:
  • Phone: 727-799-3772
  • Fax: 727-797-2957
Mailing address:
  • Phone: 727-799-3772
  • Fax: 727-797-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HERBERT P. KNAUF III
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 727-799-3772