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General NPI Number Information
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NPI Number | 1407509334
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Entity Type | Organization
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Legal Business Name | LISA A AMATO OD PA
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 10150 BLOOMINGDALE AVE
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City | RIVERVIEW
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State | FL
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Zip | 33578-3612
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Country | US
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Telephone | 813-620-4721
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 CANOPY OAKS BLVD
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City | PALM HARBOR
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State | FL
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Zip | 34683-6163
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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 | OWNER
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Name | DR. LISA A AMATO
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Credential | OD
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Telephone | 813-620-4721
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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 |
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License Number State |
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