=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437042629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RETINA CENTER TAMPA BAY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2025
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7515 STATE ROAD 52 STE 106
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-6757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-877-7710
-----------------------------------------------------
Fax | 727-877-7709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1155
-----------------------------------------------------
City | DUNEDIN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34697-1155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-877-7710
-----------------------------------------------------
Fax | 727-877-7709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANA M DUPREE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-877-7710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------