Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1952442584 |
---|---|
Provider Name | Mr. Kazuto Frank Tanaka |
First Address | Brandon, FL 33511-5819 |
Second Address | Tampa, FL 33613-4656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |