Healthcare Provider Details

I. General information

NPI: 1740416049
Provider Name (Legal Business Name): THE EYE CARE PROFESSIONALS OF TAMPA BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24412 STATE ROAD 54
LUTZ FL
33559
US

IV. Provider business mailing address

24412 STATE ROAD 54
LUTZ FL
33559
US

V. Phone/Fax

Practice location:
  • Phone: 813-949-7274
  • Fax: 813-949-2481
Mailing address:
  • Phone: 813-949-7274
  • Fax: 813-949-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID FRANKLIN SCAMARD
Title or Position: DOCTOR/OWNER
Credential: O.D.
Phone: 813-949-7274