Provider Demographics
NPI:1225468390
Name:TAMPA BAY UVEITIS CENTER
Entity Type:Organization
Organization Name:TAMPA BAY UVEITIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVY CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-862-3090
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-862-3090
Mailing Address - Fax:727-862-3023
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-862-3090
Practice Address - Fax:727-862-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH53842Medicare UPIN