Provider Demographics
NPI:1972236537
Name:HESTERMAN, THEODORE JAMES (OD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JAMES
Last Name:HESTERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:TEDDY
Other - Middle Name:
Other - Last Name:HESTERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1510 W CASS ST APT 6201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-0040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2223 N WEST SHORE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-7228
Practice Address - Country:US
Practice Address - Phone:813-524-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist