Provider Demographics
NPI:1598035057
Name:HIDALGO, JANET (OD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HIDALGO
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 1:16618 VALLELY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1131
Mailing Address - Country:US
Mailing Address - Phone:813-340-0688
Mailing Address - Fax:813-963-2931
Practice Address - Street 1:1512A E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5416
Practice Address - Country:US
Practice Address - Phone:813-971-0471
Practice Address - Fax:813-464-2763
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist