Provider Demographics
NPI:1992985774
Name:MERTZLUFFT, JOHN JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:MERTZLUFFT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2651
Mailing Address - Country:US
Mailing Address - Phone:813-814-2020
Mailing Address - Fax:813-814-9944
Practice Address - Street 1:12311 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2651
Practice Address - Country:US
Practice Address - Phone:813-814-2020
Practice Address - Fax:813-814-9944
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8138142020OtherVSP
FL24794OtherSPECTERA
FL620845200Medicaid
FL940754OtherEYEMED
FL56106OtherDAVIS VISION
FLT86287Medicare UPIN
FL56106OtherDAVIS VISION