Provider Demographics
NPI:1447328026
Name:FLORIDA RETINA INSTITUTE JAMES A STAMAN MD LLC
Entity type:Organization
Organization Name:FLORIDA RETINA INSTITUTE JAMES A STAMAN MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-997-9202
Mailing Address - Street 1:95 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1101
Mailing Address - Country:US
Mailing Address - Phone:407-849-9621
Mailing Address - Fax:407-367-6346
Practice Address - Street 1:95 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1101
Practice Address - Country:US
Practice Address - Phone:407-849-9621
Practice Address - Fax:407-367-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116137112Medicaid
FL116137117Medicaid
FL116137114Medicaid
FL116137119Medicaid
FL116137109Medicaid
FL116137102Medicaid
FL116137110Medicaid
FL116137118Medicaid
FL116137104Medicaid
FL116137105Medicaid
FL116137113Medicaid
FL064255019Medicaid
FL116137101Medicaid
FL116137103Medicaid
FL116137111Medicaid
FL116137116Medicaid
FL116137100Medicaid
FL116137106Medicaid
FL116137108Medicaid
FL116137115Medicaid
FLCA3363OtherMEDICARE RAILROAD