Provider Demographics
NPI:1558400275
Name:WILLCUT, IRMA C (DO)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:C
Last Name:WILLCUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 W COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1852
Mailing Address - Country:US
Mailing Address - Phone:813-871-5765
Mailing Address - Fax:813-873-7345
Practice Address - Street 1:3233 W COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1852
Practice Address - Country:US
Practice Address - Phone:813-871-5765
Practice Address - Fax:813-873-7345
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2758156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician