MEDICARE: CHOICE VISION CARE & WELLNESS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist

General Provider Information

NPI Number	:	1013772086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE VISION CARE & WELLNESS INC

Provider Business Mailing Address
First Line	:	628 CYPRESS KEY CIR
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1234
Country	:	US
Telephone Number	:	561-665-0437
Fax Number	:	561-516-6999

Provider Business Practice Location Address
First Line	:	8475 LAKE WORTH RD STE 200
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2427
Country	:	US
Telephone Number	:	800-520-4675
Fax Number	:	561-516-6999

Authorized Official
Title or Position	:	PRESIDENT/MEDICAL DIRECTOR
Name	:	DR. SALVATORE F DECANIO
Credential	:	OD
Telephone Number	:	561-665-0437

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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