MEDICARE: TAMPA LIGHTHOUSE FOR THE BLIND

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
1	152W00000X	Optometrist	OP-0001955	FL

General Provider Information

NPI Number	:	1356431662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA LIGHTHOUSE FOR THE BLIND

Provider Business Mailing Address
First Line	:	1106 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2142
Country	:	US
Telephone Number	:	813-251-2407
Fax Number	:	813-254-4305

Provider Business Practice Location Address
First Line	:	1106 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2142
Country	:	US
Telephone Number	:	813-251-2407
Fax Number	:	813-254-4305

Authorized Official
Title or Position	:	REHABILITATION SERVICES MANAGER
Name	:	SHERYL K BROWN
Credential	:
Telephone Number	:	813-251-2407

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	08/22/2020

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