Provider Demographics
NPI:1447316146
Name:BRITTON PLAZA VISION CENTER
Entity type:Organization
Organization Name:BRITTON PLAZA VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:813-837-0077
Mailing Address - Street 1:3802 BRITTON PLZ # A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1406
Mailing Address - Country:US
Mailing Address - Phone:813-837-0077
Mailing Address - Fax:813-839-8509
Practice Address - Street 1:3802 BRITTON PLZ # A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1406
Practice Address - Country:US
Practice Address - Phone:813-837-0077
Practice Address - Fax:813-839-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5003156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0863100001Medicare ID - Type Unspecified