MEDICARE: BARRY M GAFFNEY 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	1410	FL
2	152W00000X	Optometrist

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

General Provider Information

NPI Number	:	1962568451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY M GAFFNEY OD PA

Provider Business Mailing Address
First Line	:	403 VONDERBURG DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5982
Country	:	US
Telephone Number	:	813-681-1122
Fax Number	:	813-684-4924

Provider Business Practice Location Address
First Line	:	2002 S ALEXANDER STREET
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-8410
Country	:	US
Telephone Number	:	813-856-2020
Fax Number	:	813-754-5464

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BARRY M GAFFNEY
Credential	:	OD, PA
Telephone Number	:	813-856-2020

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	11/10/2022

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