MEDICARE: THEODORE JAMES HESTERMAN 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	OPC6133	FL

General Provider Information

NPI Number	:	1972236537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE JAMES HESTERMAN OD

Provider Business Mailing Address
First Line	:	1510 W CASS ST APT 6201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-0040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 N WEST SHORE BLVD STE 280
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-7228
Country	:	US
Telephone Number	:	813-524-5436
Fax Number	:

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

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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