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General NPI Number Information
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NPI Number | 1700692902
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Entity Type | Organization
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Legal Business Name | BEYOND 2020 VISION SPECIALISTS PORT RICHEY
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 9644 SCENIC DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-4653
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Country | US
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Telephone | 727-845-0082
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Fax | 727-847-3463
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Provider Business Mailing Address
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Address Line | 16230 STATE ROAD 54
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City | ODESSA
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State | FL
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Zip | 33556-3729
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Country | US
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Telephone | 813-926-5993
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Fax |
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Authorized Official
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Title or Position | OD
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Name | CHRISTOPHER TUMOLO
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Credential |
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Telephone | 813-926-5993
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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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