Provider Demographics
NPI:1184612780
Name:MARROTTE, RICHARD D (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:MARROTTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 3RD AVE S
Mailing Address - Street 2:APT 332
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4189
Mailing Address - Country:US
Mailing Address - Phone:561-702-0684
Mailing Address - Fax:
Practice Address - Street 1:2679 GULF TO BAY BLVD STE 560-570
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4947
Practice Address - Country:US
Practice Address - Phone:727-669-2831
Practice Address - Fax:727-333-7126
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2246 OPC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084132301Medicaid
FLU19699Medicare UPIN
FL19687Medicare ID - Type UnspecifiedPROVIDER IDENTIFIER
FL084132301Medicaid