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General NPI Number Information
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NPI Number | 1144669557
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Entity Type | Individual
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Provider Name | CASEY L KOMM D.O
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Gender | Female
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 2020 SEVEN SPRINGS BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-3933
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Country | US
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Telephone | 716-308-4679
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 SEVEN SPRINGS BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-3933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | UO 3672
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS12925
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License Number State | FL
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