Provider Demographics
NPI:1013591494
Name:FLORIDA RETINA INSTITUTE JAMES A STAMAN MD LLC
Entity Type:Organization
Organization Name:FLORIDA RETINA INSTITUTE JAMES A STAMAN MD LLC
Other - Org Name:FLORIDA RETINA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-997-9202
Mailing Address - Street 1:95 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1101
Mailing Address - Country:US
Mailing Address - Phone:407-849-9621
Mailing Address - Fax:407-367-6346
Practice Address - Street 1:564 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1492
Practice Address - Country:US
Practice Address - Phone:386-258-5777
Practice Address - Fax:386-239-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064255002Medicaid
FL116137111Medicaid