1255742979 NPI number — DR JOHN J GIARDINA OD AND ASSOCIATES OPTOMETRIC PHYSICIANS PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255742979 NPI number — DR JOHN J GIARDINA OD AND ASSOCIATES OPTOMETRIC PHYSICIANS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOHN J GIARDINA OD AND ASSOCIATES OPTOMETRIC PHYSICIANS PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255742979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 BERNARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34243-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-923-9533
Provider Business Mailing Address Fax Number:
941-924-0382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33704-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-821-9540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GIARDINA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-953-5522

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC 2352 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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