Provider Demographics
NPI:1740416049
Name:THE EYE CARE PROFESSIONALS OF TAMPA BAY
Entity Type:Organization
Organization Name:THE EYE CARE PROFESSIONALS OF TAMPA BAY
Other - Org Name:EYEGLASS FACTORY AND SHOWROOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SCAMARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-949-7274
Mailing Address - Street 1:24412 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559
Mailing Address - Country:US
Mailing Address - Phone:813-949-7274
Mailing Address - Fax:813-949-2481
Practice Address - Street 1:24412 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:813-949-7274
Practice Address - Fax:813-949-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3394152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6477030001Medicare NSC
FLP2068Medicare PIN