| |
1701 Rickenbacker Dr., Ste 102, Sun City Center, FL 33573-5361 | |
(813) 634-7788 | |
(813) 634-2266 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 1701 Rickenbacker Dr., Sun City Center, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1821082249 | NPI | - | NPPES |
060983802 | Medicaid | FL | |
0609838-02 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
403 Vonderburg Dr, Brandon, FL 33511-5982 Ph: (813) 681-1122 | 1701 Rickenbacker Dr., Ste 102, Sun City Center, FL 33573-5361 Ph: (813) 634-7788 |