Provider Demographics
NPI:1124332879
Name:FELICI, ROBERTA (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:FELICI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:FELICI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, PA
Mailing Address - Street 1:2087 LONG BOW LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6407
Mailing Address - Country:US
Mailing Address - Phone:727-204-1424
Mailing Address - Fax:
Practice Address - Street 1:900 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1035
Practice Address - Country:US
Practice Address - Phone:727-204-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003009152W00000X
FLOPC 3993152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation