MEDICARE: BAY AREA RETINA SPECIALISTS 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1891254512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA RETINA SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	4178 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6429
Country	:	US
Telephone Number	:	813-999-3998
Fax Number	:	813-522-3371

Provider Business Practice Location Address
First Line	:	4178 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6429
Country	:	US
Telephone Number	:	813-999-3998
Fax Number	:	813-522-3371

Authorized Official
Title or Position	:	DOCTOR PROVIDER/OWNER
Name	:	DR. FAYSSAL EL-JABALI
Credential	:	DO
Telephone Number	:	813-999-3998

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	07/29/2024

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