Provider Demographics
NPI:1598783235
Name:SANTOS, JOSE (OD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333WEST WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2711
Mailing Address - Country:US
Mailing Address - Phone:813-932-2020
Mailing Address - Fax:813-932-2001
Practice Address - Street 1:3333WEST WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2758
Practice Address - Country:US
Practice Address - Phone:813-932-2020
Practice Address - Fax:813-932-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002256152W00000X
FLOPC 4173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ661ZMedicare PIN