Provider Demographics
NPI:1093965964
Name:BUSSA, STEVE TIMOTHY (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:TIMOTHY
Last Name:BUSSA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2205
Mailing Address - Country:US
Mailing Address - Phone:954-625-2388
Mailing Address - Fax:954-625-2390
Practice Address - Street 1:7045 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2205
Practice Address - Country:US
Practice Address - Phone:954-625-2388
Practice Address - Fax:954-625-2390
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4301152W00000X
NV627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTYNMD3P3Medicaid
FLTYNMD3P3Medicaid