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General NPI Number Information
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NPI Number | 1285789156
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Entity Type | Individual
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Provider Name | BRIAN TRIBUNELLA OD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-9261
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Country | US
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Telephone | 813-994-2614
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 COURTNEY MEADOWS CT APT 303
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City | TAMPA
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State | FL
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Zip | 33619-8510
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3768
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License Number State | FL
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