Provider Demographics
NPI:1285939728
Name:VINCENT B AZZUE, O.D., P.A.
Entity type:Organization
Organization Name:VINCENT B AZZUE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:BARTH
Authorized Official - Last Name:AZZUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-844-3223
Mailing Address - Street 1:8505 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4924
Mailing Address - Country:US
Mailing Address - Phone:727-844-3223
Mailing Address - Fax:727-844-3201
Practice Address - Street 1:8505 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-4924
Practice Address - Country:US
Practice Address - Phone:727-844-3223
Practice Address - Fax:727-844-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620149100Medicaid
FL620149100Medicaid