Provider Demographics
NPI:1154631174
Name:TAMPA BAY OPTICAL INC.
Entity Type:Organization
Organization Name:TAMPA BAY OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDEAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS OD
Authorized Official - Phone:813-877-2400
Mailing Address - Street 1:4710 N HABANA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7146
Mailing Address - Country:US
Mailing Address - Phone:813-877-2400
Mailing Address - Fax:813-877-2402
Practice Address - Street 1:4710 N HABANA AVE STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7146
Practice Address - Country:US
Practice Address - Phone:813-877-2400
Practice Address - Fax:813-877-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty