Healthcare Provider Details

I. General information

NPI: 1770566747
Provider Name (Legal Business Name): ANTHONY EFRE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5537 SHELDON RD SUITE A
TAMPA FL
33615-3153
US

IV. Provider business mailing address

5537 SHELDON RD SUITE A
TAMPA FL
33615-3153
US

V. Phone/Fax

Practice location:
  • Phone: 813-806-0812
  • Fax: 813-249-2049
Mailing address:
  • Phone: 813-806-0812
  • Fax: 813-249-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOP002785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: