Provider Demographics
NPI:1770566747
Name:EFRE, ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:EFRE
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 1:5537 SHELDON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3153
Mailing Address - Country:US
Mailing Address - Phone:813-806-0812
Mailing Address - Fax:813-249-2049
Practice Address - Street 1:5537 SHELDON RD
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3153
Practice Address - Country:US
Practice Address - Phone:813-806-0812
Practice Address - Fax:813-249-2049
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP002785207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620642501Medicaid
FL620642502Medicaid
FP907AOtherGROUP PTAN
FL620642500Medicaid
20663AMedicare ID - Type Unspecified
FL620642502Medicaid
FL620642500Medicaid