Healthcare Provider Details

I. General information

NPI: 1376675454
Provider Name (Legal Business Name): ANTONIO PRADO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7522 N HIMES AVE
TAMPA FL
33614-3205
US

IV. Provider business mailing address

7522 N HIMES AVE
TAMPA FL
33614-3205
US

V. Phone/Fax

Practice location:
  • Phone: 813-931-0500
  • Fax:
Mailing address:
  • Phone: 813-931-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME64750
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO PRADO
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 813-931-0500