MEDICARE: STRABISMUS SURGEONS OF TAMPA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician

General Provider Information

NPI Number	:	1588557458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRABISMUS SURGEONS OF TAMPA LLC

Provider Business Mailing Address
First Line	:	5420 WEBB RD STE B2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 WEBB RD STE B2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3255
Country	:	US
Telephone Number	:	606-692-0789
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING AND CONTRACTING SPECI
Name	:	PHAEDRA L SHUDRA
Credential	:
Telephone Number	:	813-785-4861

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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