MEDICARE: VERRETT VISION ASSOCIATES, LLC

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	1267-421T	LA

General Provider Information

NPI Number	:	1063662328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERRETT VISION ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1966 NE 123RD ST
Second Line	:	128
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2868
Country	:	US
Telephone Number	:	504-782-4855
Fax Number	:

Provider Business Practice Location Address
First Line	:	1966 NE 123RD ST
Second Line	:	128
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2868
Country	:	US
Telephone Number	:	504-782-4855
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. KEELEY W VERRETT
Credential	:	O.D.
Telephone Number	:	504-782-4855

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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