=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952442584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. KAZUTO FRANK TANAKA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 E FLETCHER AVE SUITE 310
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-4656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-978-1142
-----------------------------------------------------
Fax | 813-975-0921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 WESTWOOD LN
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-684-2727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1700X
-----------------------------------------------------
Taxonomy Name | Ocularist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------