Provider Demographics
NPI:1992188015
Name:TAMPA BAY UVEITIS CENTER LLC
Entity type:Organization
Organization Name:TAMPA BAY UVEITIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY-CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-317-5830
Mailing Address - Street 1:1703 N MCMULLEN BOOTH RD UNIT 764
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-9630
Mailing Address - Country:US
Mailing Address - Phone:727-317-5830
Mailing Address - Fax:888-539-6488
Practice Address - Street 1:5800 49TH ST N STE S108
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2146
Practice Address - Country:US
Practice Address - Phone:727-317-5830
Practice Address - Fax:888-539-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99689261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty