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Organization
SILOAM MEDICAL
Active
Organization
SILOAM MEDICAL
Active
Other names
Beatific Vision
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS BOTTARO DO (OWNER)
(813) 330-0574
Entity
Organization
Contact information
Practice address
15123 OGDEN LOOP, ODESSA, FL 33556-4633
(860) 268-6617
Mailing address
15123 OGDEN LOOP, ODESSA, FL 33556-4633
(813) 330-0574
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
—
NULL
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
NULL
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
207WX0120X
Cornea and External Diseases Specialist Physician
—
NULL
207WX0120X
Cornea and External Diseases Specialist Physician
—
—
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
—
NULL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108311400
—
FL
Enumeration date
05/24/2021
Last updated
09/04/2026
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