Provider Demographics
NPI:1063613347
Name:TAYLOR-MARTINO, TIFFANY L (OD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:L
Last Name:TAYLOR-MARTINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 N ALAFAYA TRL STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2945
Mailing Address - Country:US
Mailing Address - Phone:407-447-7793
Mailing Address - Fax:407-447-7887
Practice Address - Street 1:3151 N ALAFAYA TRL STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2945
Practice Address - Country:US
Practice Address - Phone:407-447-7793
Practice Address - Fax:407-447-7887
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL0003287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist