# SILOAM MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beatific Vision
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154996072
- **Authorized official:** NICHOLAS BOTTARO DO (OWNER)
- **Authorized official phone:** (813) 330-0574

## Contact information

- **Practice address:** 15123 OGDEN LOOP, ODESSA, FL 33556-4633
- **Practice address phone:** (860) 268-6617
- **Mailing address:** 15123 OGDEN LOOP, ODESSA, FL 33556-4633
- **Mailing address phone:** (813) 330-0574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 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

- **Enumeration date:** 05/24/2021
- **Last updated:** 09/04/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 108311400 | — | FL |