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General NPI Number Information
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NPI Number | 1669162707
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Entity Type | Individual
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Provider Name | TONYA CLAIR MESROBIAN
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Gender | Female
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 5800 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3110
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Country | US
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Telephone | 863-815-4408
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Fax | 863-815-4599
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Provider Business Mailing Address
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Address Line | 1418 BRAMBLEWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33811-2946
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Country | US
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Telephone | 863-640-0772
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO5327
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License Number State | FL
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