Healthcare Provider Details

I. General information

NPI: 1396060083
Provider Name (Legal Business Name): DRS CARLSON, HOLLIS, & TERREZZA AND ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N FAIRFIELD DR
PENSACOLA FL
32506-4313
US

IV. Provider business mailing address

1815 E FOWLER AVE
TAMPA FL
33612-5525
US

V. Phone/Fax

Practice location:
  • Phone: 850-456-5059
  • Fax: 850-456-0461
Mailing address:
  • Phone: 813-979-2929
  • Fax: 813-979-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER J DUKES
Title or Position: INSURANCE MANAGER
Credential:
Phone: 850-456-5059