Provider Demographics
NPI:1194717678
Name:BILLINGS, RICKY JAY
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:JAY
Last Name:BILLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CLARK RD STE E2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2301
Mailing Address - Country:US
Mailing Address - Phone:941-923-1119
Mailing Address - Fax:941-923-1858
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-923-1119
Practice Address - Fax:941-923-1858
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078536900Medicaid
FLT84192Medicare UPIN
FL19519Medicare PIN
FL0478240001Medicare NSC