Provider Demographics
NPI:1770660029
Name:ZEITLIN, ANDREA MARISSA (OD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARISSA
Last Name:ZEITLIN
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 1:9420 GEORGIAN PARK LN APT 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5179
Mailing Address - Country:US
Mailing Address - Phone:941-228-1373
Mailing Address - Fax:
Practice Address - Street 1:2266 UNIVERSITY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5518
Practice Address - Country:US
Practice Address - Phone:813-978-3263
Practice Address - Fax:813-977-0660
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist