| NPI | 1710353479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RICHARD STATSICK O PT Ometrist 813-385-4738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2303) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2025-07-16 |