Provider Demographics
NPI:1275690075
Name:TAMPA BAY OPTOMETRIC GROUP PA
Entity Type:Organization
Organization Name:TAMPA BAY OPTOMETRIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-361-0431
Mailing Address - Street 1:PO BOX 40510
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-0510
Mailing Address - Country:US
Mailing Address - Phone:727-361-0431
Mailing Address - Fax:727-344-7952
Practice Address - Street 1:14901 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1801
Practice Address - Country:US
Practice Address - Phone:813-960-8958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty