Provider Demographics
NPI:1235366931
Name:GARCIA, DENNIS M (OD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260816
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33685-0816
Mailing Address - Country:US
Mailing Address - Phone:813-590-2020
Mailing Address - Fax:813-603-4420
Practice Address - Street 1:3109 W SWANN AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4701
Practice Address - Country:US
Practice Address - Phone:813-590-2020
Practice Address - Fax:813-603-4420
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2153152W00000X
VA0618001842152W00000X
FLOPC4977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235366931Medicaid
NCNC2468C439Medicare PIN