Provider Demographics
NPI:1063645828
Name:SARIVANNARA, BOBBY (OD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:SARIVANNARA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325TH MEDICAL GROUP
Mailing Address - Street 2:340 MAGNOLIA CIR BLDG 1465
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403-5604
Mailing Address - Country:US
Mailing Address - Phone:850-283-7108
Mailing Address - Fax:
Practice Address - Street 1:325TH MEDICAL GROUP
Practice Address - Street 2:340 MAGNOLIA CIR BLDG 1465
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403-5604
Practice Address - Country:US
Practice Address - Phone:850-283-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4488152W00000X
FLOPC 4488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist