Provider Demographics
NPI:1730385881
Name:COSMO J ANASTASI O D P A
Entity type:Organization
Organization Name:COSMO J ANASTASI O D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COSMO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANASTASI
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:813-866-9255
Mailing Address - Street 1:16313 ASHINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2644
Mailing Address - Country:US
Mailing Address - Phone:813-866-9255
Mailing Address - Fax:813-866-0445
Practice Address - Street 1:2021 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4701
Practice Address - Country:US
Practice Address - Phone:813-657-5448
Practice Address - Fax:813-657-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7916OtherMEDICARE GRP#
FL19500ZMedicare ID - Type Unspecified
FLK7916OtherMEDICARE GRP#