Provider Demographics
NPI:1073906194
Name:SHAMIKA L HONEYBLUE OD PA
Entity Type:Organization
Organization Name:SHAMIKA L HONEYBLUE OD PA
Other - Org Name:HAINES VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIKA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HONEYBLUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-521-2020
Mailing Address - Street 1:4601 GRAYVIEW CT
Mailing Address - Street 2:APT 209C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-5000
Mailing Address - Country:US
Mailing Address - Phone:727-521-2020
Mailing Address - Fax:727-521-6762
Practice Address - Street 1:7211 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4613
Practice Address - Country:US
Practice Address - Phone:727-521-2020
Practice Address - Fax:727-521-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty