Healthcare Provider Details

I. General information

NPI: 1871056804
Provider Name (Legal Business Name): JANET HIDALGO, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 W HILLSBOROUGH AVE STE F
TAMPA FL
33634-5309
US

IV. Provider business mailing address

5011 W HILLSBOROUGH AVE STE F
TAMPA FL
33634-5309
US

V. Phone/Fax

Practice location:
  • Phone: 813-373-5873
  • Fax: 813-609-6475
Mailing address:
  • Phone: 813-373-5873
  • Fax: 813-609-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JANET O HIDALGO
Title or Position: OWNER
Credential: OD
Phone: 813-373-5873