Provider Demographics
NPI:1780716209
Name:WEBB, MARIAN U (OD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:U
Last Name:WEBB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 45TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5248
Mailing Address - Country:US
Mailing Address - Phone:727-625-9240
Mailing Address - Fax:
Practice Address - Street 1:2300 TYRONE BLVD N
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3924
Practice Address - Country:US
Practice Address - Phone:727-341-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20256Medicare ID - Type Unspecified