Provider Demographics
NPI:1699943431
Name:LLOYD FIRESTONE
Entity type:Organization
Organization Name:LLOYD FIRESTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-961-6702
Mailing Address - Street 1:14958 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1626
Mailing Address - Country:US
Mailing Address - Phone:813-961-6702
Mailing Address - Fax:813-968-6994
Practice Address - Street 1:14958 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1626
Practice Address - Country:US
Practice Address - Phone:813-961-6702
Practice Address - Fax:813-968-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0652080001Medicare NSC
FL19328Medicare UPIN