Provider Demographics
NPI:1295911709
Name:FAZIO EYE INSTITUTE, PA
Entity type:Organization
Organization Name:FAZIO EYE INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KERRIS-FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-677-1424
Mailing Address - Street 1:5208 E FOWLER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1906
Mailing Address - Country:US
Mailing Address - Phone:813-988-1163
Mailing Address - Fax:813-988-7563
Practice Address - Street 1:5208 E FOWLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1906
Practice Address - Country:US
Practice Address - Phone:813-988-1163
Practice Address - Fax:813-988-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty