Provider Demographics
NPI:1881095545
Name:ANDREW ROTHBERG OD PA
Entity type:Organization
Organization Name:ANDREW ROTHBERG OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROTHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-854-9000
Mailing Address - Street 1:12950 RACE TRACK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1304
Mailing Address - Country:US
Mailing Address - Phone:813-854-9000
Mailing Address - Fax:813-579-2063
Practice Address - Street 1:12950 RACE TRACK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1309
Practice Address - Country:US
Practice Address - Phone:727-244-3368
Practice Address - Fax:832-934-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty