Provider Demographics
NPI:1154423416
Name:ROBERT B SCOTT OCULARISTS OF FLORIDA
Entity type:Organization
Organization Name:ROBERT B SCOTT OCULARISTS OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-782-3558
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:SUITE 1516
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3066
Mailing Address - Country:US
Mailing Address - Phone:312-782-3558
Mailing Address - Fax:312-372-4449
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4793
Practice Address - Country:US
Practice Address - Phone:813-977-7676
Practice Address - Fax:813-977-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2009-07-20
Deactivation Date:2009-03-06
Deactivation Code:
Reactivation Date:2009-07-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
231983OtherAMERIGROUP
N3179OtherWELLCARE
N3179OtherHEALTHEASE
TN4017986OtherBCBS TN
FL027891200Medicaid
214220OtherAVMED
N3179OtherSTAYWELL
2436832OtherAETNA
M0331OtherBSBS
10633501OtherCITRUS
214220OtherAVMED
N3179OtherWELLCARE
231983OtherAMERIGROUP