Provider Demographics
NPI:1588557458
Name:STRABISMUS SURGEONS OF TAMPA LLC
Entity type:Organization
Organization Name:STRABISMUS SURGEONS OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND CONTRACTING SPECI
Authorized Official - Prefix:
Authorized Official - First Name:PHAEDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHUDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-785-4861
Mailing Address - Street 1:5420 WEBB RD STE B2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5420 WEBB RD STE B2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3255
Practice Address - Country:US
Practice Address - Phone:606-692-0789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Multi-Specialty