Provider Demographics
NPI:1275047128
Name:ALABATA EYE CENTER LLC
Entity Type:Organization
Organization Name:ALABATA EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALABATA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-331-3937
Mailing Address - Street 1:239 REDSTONE AVE W
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6465
Mailing Address - Country:US
Mailing Address - Phone:850-331-3937
Mailing Address - Fax:850-634-6136
Practice Address - Street 1:239 REDSTONE AVE W
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6465
Practice Address - Country:US
Practice Address - Phone:850-331-3937
Practice Address - Fax:850-634-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9285207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270664400Medicaid