=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154423416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT B SCOTT OCULARISTS OF FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 07/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 E FLETCHER AVE SUITE 509
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-4793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-977-7676
-----------------------------------------------------
Fax | 813-977-1999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 N WABASH AVE SUITE 1516
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-782-3558
-----------------------------------------------------
Fax | 312-372-4449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/TREASURER
-----------------------------------------------------
Name | BONNY J SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-782-3558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------