Provider Demographics
NPI:1528036357
Name:JOHN J MERTZLUFFT OD PA
Entity Type:Organization
Organization Name:JOHN J MERTZLUFFT OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MERTZLUFFT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-814-2020
Mailing Address - Street 1:12037 WHITMARSH LANE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:813-814-2020
Mailing Address - Fax:
Practice Address - Street 1:12037 WHITMARSH LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1737
Practice Address - Country:US
Practice Address - Phone:813-814-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620845200Medicaid
8138142020OtherVSP
56106OtherDAVIS VISION
FL24794OtherSPECTERA
FL24794OtherSPECTERA
FL620845200Medicaid