Provider Demographics
NPI:1265929780
Name:B&B FLORIDA EYE CARE PLLC
Entity type:Organization
Organization Name:B&B FLORIDA EYE CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-392-3636
Mailing Address - Street 1:13553 STATE ROAD 54 PMB 303
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4504
Mailing Address - Country:US
Mailing Address - Phone:405-509-9321
Mailing Address - Fax:
Practice Address - Street 1:1380 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-498-5117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B&B FLORIDA EYE CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-19
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5312152W00000X
FLOPC5316152W00000X
FLOPC5309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty