=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255446431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS P STAMP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6248 COMMERCIAL WAY
-----------------------------------------------------
City | WEEKI WACHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-6329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-597-3205
-----------------------------------------------------
Fax | 352-597-3204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6248 COMMERCIAL WAY
-----------------------------------------------------
City | WEEKI WACHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-6329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-597-3205
-----------------------------------------------------
Fax | 352-597-3204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC3401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------