MEDICARE: CAROL ANN EBERT-GORB, O.D.

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	152W00000X	Optometrist	OPC2173	FL

General Provider Information

NPI Number	:	1033509781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL ANN EBERT-GORB, O.D.

Provider Business Mailing Address
First Line	:	4924 ARDEN FOREST WAY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-2958
Country	:	US
Telephone Number	:	850-668-3693
Fax Number	:	850-668-3693

Provider Business Practice Location Address
First Line	:	1500 APALACHEE PKWY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3055
Country	:	US
Telephone Number	:	850-656-8980
Fax Number	:	580-656-8980

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CAROL ANN EBERT-GORB
Credential	:	O.D.
Telephone Number	:	850-668-3693

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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