Provider Demographics
NPI:1275799272
Name:ITALIAN AND INDIAN ADVENTURES INC
Entity Type:Organization
Organization Name:ITALIAN AND INDIAN ADVENTURES INC
Other - Org Name:DESOTO VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:941-747-5567
Mailing Address - Street 1:3611 1ST ST
Mailing Address - Street 2:SUITE 640
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4400
Mailing Address - Country:US
Mailing Address - Phone:941-747-5567
Mailing Address - Fax:941-748-0761
Practice Address - Street 1:3611 1ST ST
Practice Address - Street 2:SUITE 640
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4400
Practice Address - Country:US
Practice Address - Phone:941-747-5567
Practice Address - Fax:941-748-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1473332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD6744OtherBCBS OF FLORIDA