Healthcare Provider Details

I. General information

NPI: 1316989627
Provider Name (Legal Business Name): JENNIFER BUZZETT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13129G N DALE MABRY HWY
TAMPA FL
33618-2405
US

IV. Provider business mailing address

2606 S ESPERANZA AVE
TAMPA FL
33629-7113
US

V. Phone/Fax

Practice location:
  • Phone: 813-962-1799
  • Fax: 813-962-3139
Mailing address:
  • Phone: 813-831-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 2662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: