Provider Demographics
NPI:1114197126
Name:ADVANCED PEDIATRIC OPHTHALMOLOGY AND ADULT STRABISMUS
Entity Type:Organization
Organization Name:ADVANCED PEDIATRIC OPHTHALMOLOGY AND ADULT STRABISMUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSOUM-HOMSY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-910-5240
Mailing Address - Street 1:12220 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9201
Mailing Address - Country:US
Mailing Address - Phone:813-910-5240
Mailing Address - Fax:813-631-5046
Practice Address - Street 1:12220 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9201
Practice Address - Country:US
Practice Address - Phone:813-910-5240
Practice Address - Fax:813-631-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72301207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG64274Medicare UPIN
FL41388Medicare PIN