=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689161259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B&B FLORIDA EYE CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2018
-----------------------------------------------------
Last Update Date | 08/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2670 GULF TO BAY BLVD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33759-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-777-4546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13553 STATE ROAD 54 PMB 303
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33556-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-509-3217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JEFF M BUTCHER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 813-392-3636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC5309
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------