Provider Demographics
NPI:1467701086
Name:CAMARGO, TARA KOZA (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:KOZA
Last Name:CAMARGO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1501
Mailing Address - Country:US
Mailing Address - Phone:727-898-3155
Mailing Address - Fax:727-821-1912
Practice Address - Street 1:11212 PARK BLVD
Practice Address - Street 2:VISION WORKS
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33774
Practice Address - Country:US
Practice Address - Phone:727-397-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist