=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285939728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINCENT B AZZUE, O.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2011
-----------------------------------------------------
Last Update Date | 01/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8505 LITTLE RD
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34654-4924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-844-3223
-----------------------------------------------------
Fax | 727-844-3201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8505 LITTLE RD
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34654-4924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-844-3223
-----------------------------------------------------
Fax | 727-844-3201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. VINCENT BARTH AZZUE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 727-844-3223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC 2877
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------