Healthcare Provider Details

I. General information

NPI: 1497669790
Provider Name (Legal Business Name): LYDIA EVANGELINE FASIG LDO, ABOC, NCLEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2798 E FOWLER AVE STE 940
TAMPA FL
33612-6207
US

IV. Provider business mailing address

6270 MERRIFIELD DR
ZEPHYRHILLS FL
33541-2176
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-5728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberDO8499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: