Provider Demographics
NPI:1720078926
Name:TRAWICK, ANTHONY B (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:B
Last Name:TRAWICK
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 1:5125 S LAKELAND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2578
Mailing Address - Country:US
Mailing Address - Phone:863-644-7773
Mailing Address - Fax:863-646-2809
Practice Address - Street 1:5125 S LAKELAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2578
Practice Address - Country:US
Practice Address - Phone:863-644-7773
Practice Address - Fax:863-646-2809
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078367600Medicaid
FL19457ZMedicare PIN
FL0508400001Medicare NSC
FLP00883029Medicare PIN
FL078367600Medicaid