Provider Demographics
NPI:1548455074
Name:JOSEPH J HATALA OD PA
Entity type:Organization
Organization Name:JOSEPH J HATALA OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATALA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-669-6369
Mailing Address - Street 1:27001 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3402
Mailing Address - Country:US
Mailing Address - Phone:727-669-6369
Mailing Address - Fax:
Practice Address - Street 1:27001 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 2004
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3402
Practice Address - Country:US
Practice Address - Phone:727-669-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02588Medicare UPIN
FL20180Medicare PIN