Provider Demographics
NPI:1205470101
Name:DR. STEVE T. BUSSA O.D., P.L.L.C.
Entity type:Organization
Organization Name:DR. STEVE T. BUSSA O.D., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-232-0513
Mailing Address - Street 1:1201 N FEDERAL HWY
Mailing Address - Street 2:STE 2A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33338-4099
Mailing Address - Country:US
Mailing Address - Phone:775-232-0513
Mailing Address - Fax:
Practice Address - Street 1:7045 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2205
Practice Address - Country:US
Practice Address - Phone:954-625-2388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER EYE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107890500Medicaid