Provider Demographics
NPI:1497114680
Name:BERRYMAN, CLARA THERESA
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:THERESA
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 W AZEELE ST
Mailing Address - Street 2:#3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-7100
Mailing Address - Country:US
Mailing Address - Phone:813-872-0480
Mailing Address - Fax:813-872-0480
Practice Address - Street 1:2608 W AZEELE ST
Practice Address - Street 2:#3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-7100
Practice Address - Country:US
Practice Address - Phone:813-872-0480
Practice Address - Fax:813-872-0480
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist