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General NPI Number Information
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NPI Number | 1528036357
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Entity Type | Organization
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Legal Business Name | JOHN J MERTZLUFFT OD PA
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 12037 WHITMARSH LN
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City | TAMPA
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State | FL
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Zip | 33626-1737
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Country | US
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Telephone | 813-814-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 12037 WHITMARSH LANE
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City | TAMPA
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State | FL
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Zip | 33626
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Country | US
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Telephone | 813-814-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT DOCTOR
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Name | DR. JOHN JOSEPH MERTZLUFFT
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Credential | OD
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Telephone | 813-814-2020
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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 | 2610
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License Number State | FL
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