Healthcare Provider Details

I. General information

NPI: 1598035057
Provider Name (Legal Business Name): JANET HIDALGO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512A E FOWLER AVE
TAMPA FL
33612-5416
US

IV. Provider business mailing address

16618 VALLELY DR
TAMPA FL
33618-1131
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-0471
  • Fax: 813-464-2763
Mailing address:
  • Phone: 813-340-0688
  • Fax: 813-963-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: