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NPI Code Detail

MEDICARE: TAMPA LIGHTHOUSE FOR THE BLIND INC.

MEDICARE: TAMPA LIGHTHOUSE FOR THE BLIND 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
1152W00000XOptometristOP0001955FL

General Provider Information

NPI Number : 1447491709
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAMPA LIGHTHOUSE FOR THE BLIND INC.
Provider Business Mailing Address
First Line : 1106 WEST PLATT STREET
Second Line :
City : TAMPA
State : FL
Zip : 33606
Country : US
Telephone Number : 813-251-2407
Fax Number : 813-254-4305
Provider Business Practice Location Address
First Line : 1106 W. PLATT STREET
Second Line :
City : TAMPA
State : FL
Zip : 33606
Country : US
Telephone Number : 813-251-2407
Fax Number : 813-254-4305
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. CLIFF E. OLSTROM
Credential :
Telephone Number : 813-251-2407
Provider Enumeration Date : 03/17/2009
Last Update Date : 03/17/2009

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