MEDICARE: ST PETE OPTICAL INC

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	332H00000X	Eyewear Supplier	DO2094	FL

General Provider Information

NPI Number	:	1427298058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST PETE OPTICAL INC

Provider Business Mailing Address
First Line	:	3210 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	727-894-2020
Fax Number	:	727-894-0300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NANCY JO MCGETTRICK
Credential	:
Telephone Number	:	727-894-2020

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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Directions to “ST PETE OPTICAL INC ” Practice Location

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