1265929780 NPI number — B&B FLORIDA EYE CARE PLLC

Table of content: (NPI 1265929780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265929780 NPI number — B&B FLORIDA EYE CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B&B FLORIDA EYE CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLORIDA EYE CARE- 4TH ST.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265929780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13553 STATE ROAD 54 PMB 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33556-4504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-509-9321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-498-5117
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
MIA
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTHCARE ADMINISTRATOR
Authorized Official Telephone Number:
813-392-3636

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC5309 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OPC5312 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OPC5316 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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