Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO4859 | FL |
NPI | 1083794788 |
---|---|
Provider Name | Michael D'anna |
First Address | Tampa, FL 33604-6643 |
Second Address | Plant City, FL 33563-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |