Provider Demographics
NPI:1447491709
Name:TAMPA LIGHTHOUSE FOR THE BLIND INC.
Entity type:Organization
Organization Name:TAMPA LIGHTHOUSE FOR THE BLIND INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-251-2407
Mailing Address - Street 1:1106 WEST PLATT STREET
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:813-251-2407
Mailing Address - Fax:813-254-4305
Practice Address - Street 1:1106 W. PLATT STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-251-2407
Practice Address - Fax:813-254-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0001955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39098Medicare PIN