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General NPI Number Information
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NPI Number | 1245645498
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Entity Type | Individual
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Provider Name | VICTORIA COLASURDO TARBUTTON O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 01/22/2022
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Provider Practice Location Address
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Address Line | 28330 PASEO DR STE 180
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-5412
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Country | US
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Telephone | 813-994-4867
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Fax | 813-994-4137
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Provider Business Mailing Address
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Address Line | 8421 EDGEWATER PLACE BLVD
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City | TAMPA
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State | FL
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Zip | 33615-1389
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Country | US
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Telephone | 727-534-0710
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4944
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License Number State | FL
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