Provider Demographics
NPI:1952442584
Name:TANAKA, KAZUTO FRANK
Entity Type:Individual
Prefix:MR
First Name:KAZUTO
Middle Name:FRANK
Last Name:TANAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5819
Mailing Address - Country:US
Mailing Address - Phone:813-684-2727
Mailing Address - Fax:
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-978-1142
Practice Address - Fax:813-975-0921
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0681940001Medicare ID - Type Unspecified