MEDICARE: JOSE SANTOS OD

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	OPT002256	GA
2	152W00000X	Optometrist	OPC 4173	FL

General Provider Information

NPI Number	:	1598783235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE SANTOS OD

Provider Business Mailing Address
First Line	:	3333WEST WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2711
Country	:	US
Telephone Number	:	813-932-2020
Fax Number	:	813-932-2001

Provider Business Practice Location Address
First Line	:	3333WEST WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2758
Country	:	US
Telephone Number	:	813-932-2020
Fax Number	:	813-932-2001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/04/2014

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Directions to “ JOSE SANTOS OD” Practice Location

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