Individual
DR. GARY L. WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
13489 WALSINGHAM RD, LARGO, FL 33774-3530
(727) 596-6315
Mailing address
6201 BURLINGTON AVE N, ST PETERSBURG, FL 33710-8429
(727) 347-5816
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1093
GA
152W00000X
Optometrist
Primary
OPC2136
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5929A
TRICARE
FL
Enumeration date
06/08/2006
Last updated
07/17/2007
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