Individual
MAI VO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
14941 N DALE MABRY HWY, TAMPA, FL 33618-1801
(813) 969-3600
Mailing address
8829 CAMERON CREST DR, TAMPA, FL 33626-4732
(813) 205-5863
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 5122
FL
152WC0802X
Corneal and Contact Management Optometrist
OPC 5122
FL
Other
Enumeration date
09/11/2015
Last updated
09/11/2015
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