MEDICARE: JOHN J MERTZLUFFT OD PA

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	2610	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8138142020	OTHER		VSP
3	56106	OTHER		DAVIS VISION
4	24794	OTHER	FL	SPECTERA

General Provider Information

NPI Number	:	1528036357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN J MERTZLUFFT OD PA

Provider Business Mailing Address
First Line	:	12037 WHITMARSH LANE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626
Country	:	US
Telephone Number	:	813-814-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	12037 WHITMARSH LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1737
Country	:	US
Telephone Number	:	813-814-2020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT DOCTOR
Name	:	DR. JOHN JOSEPH MERTZLUFFT
Credential	:	OD
Telephone Number	:	813-814-2020

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/14/2009

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