Provider Demographics
NPI:1205831153
Name:MALONE, TIFFANY T (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:T
Last Name:MALONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 TIMBERLANE RD
Mailing Address - Street 2:BIG BEND FAMILY EYE CARE
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1766
Mailing Address - Country:US
Mailing Address - Phone:850-999-6926
Mailing Address - Fax:850-999-8950
Practice Address - Street 1:1394 TIMBERLANE RD
Practice Address - Street 2:BIG BEND FAMILY EYE CARE
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1766
Practice Address - Country:US
Practice Address - Phone:850-999-6926
Practice Address - Fax:850-999-8950
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620985200Medicaid
FLV03973Medicare UPIN
FL68176YMedicare PIN