Provider Demographics
NPI:1194886507
Name:SCOZZARI, MARY P (OD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
Last Name:SCOZZARI
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:PO BOX 7736
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-0113
Mailing Address - Country:US
Mailing Address - Phone:516-924-4412
Mailing Address - Fax:
Practice Address - Street 1:700 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4409
Practice Address - Country:US
Practice Address - Phone:813-877-4935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005230152W00000X
FLOPC2551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC3A261Medicare ID - Type Unspecified
NYU53644Medicare UPIN