Healthcare Provider Details

I. General information

NPI: 1952982886
Provider Name (Legal Business Name): OCULOFACIAL SURGERY AND COSMETIC LASER INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24420 STATE ROAD 54
LUTZ FL
33559-7303
US

IV. Provider business mailing address

24420 STATE ROAD 54
LUTZ FL
33559-7303
US

V. Phone/Fax

Practice location:
  • Phone: 813-303-0123
  • Fax: 813-587-9861
Mailing address:
  • Phone: 813-303-0123
  • Fax: 813-587-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSHNI U RANJIT-REEVES
Title or Position: OWNER / PROVIDER
Credential: MD
Phone: 813-303-0123