Healthcare Provider Details

I. General information

NPI: 1174537690
Provider Name (Legal Business Name): TROY BELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 SUITE 390
PACE FL
32571-1096
US

IV. Provider business mailing address

3754 HIGHWAY 90 SUITE 390
PACE FL
32571-1096
US

V. Phone/Fax

Practice location:
  • Phone: 850-266-7500
  • Fax: 850-290-5952
Mailing address:
  • Phone: 850-266-7500
  • Fax: 850-290-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001531
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: