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NPI Code Detail

MEDICARE: KIMBERLY ANN SPICZKA LDO

MEDICARE: KIMBERLY ANN SPICZKA LDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOpticianDO7884FL

General Provider Information

NPI Number : 1275225328
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANN SPICZKA LDO
Provider Business Mailing Address
First Line : 8114 SYLVAN DR
Second Line :
City : HUDSON
State : FL
Zip : 34667-1443
Country : US
Telephone Number : 309-267-3985
Fax Number :
Provider Business Practice Location Address
First Line : 8701 US HIGHWAY 19
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-5349
Country : US
Telephone Number : 727-848-9571
Fax Number : 727-848-5780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2023
Last Update Date : 05/25/2023

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Directions to “ KIMBERLY ANN SPICZKA LDO” Practice Location

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