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General NPI Number Information
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NPI Number | 1629388301
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Entity Type | Individual
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Provider Name | MICHELLE DIANE FEKETE O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 2747 GULF TO BAY BLVD
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City | CLEARWATER
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State | FL
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Zip | 33759-3945
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Country | US
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Telephone | 727-726-3207
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Fax | 727-431-0236
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Provider Business Mailing Address
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Address Line | 10441 LIGHTNER BRIDGE DR
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City | TAMPA
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State | FL
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Zip | 33626-1815
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Country | US
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Telephone | 901-849-4148
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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 | OPC004574
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License Number State | FL
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