Healthcare Provider Details

I. General information

NPI: 1447328026
Provider Name (Legal Business Name): FLORIDA RETINA INSTITUTE JAMES A STAMAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLUMBIA ST
ORLANDO FL
32806-1101
US

IV. Provider business mailing address

95 COLUMBIA ST
ORLANDO FL
32806-1101
US

V. Phone/Fax

Practice location:
  • Phone: 407-849-9621
  • Fax: 407-367-6346
Mailing address:
  • Phone: 407-849-9621
  • Fax: 407-367-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA DIANE STUCKEY
Title or Position: ADMINISTRATIVE SUPERVISOR
Credential:
Phone: 904-997-9202