MEDICARE: DR. JENNIFER CAPAZ PACHECO 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	OPC4890	FL

General Provider Information

NPI Number	:	1063830073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER CAPAZ PACHECO O.D.

Provider Business Mailing Address
First Line	:	1205 S POWERLINE RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4311
Country	:	US
Telephone Number	:	954-977-6636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 S POWERLINE RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4311
Country	:	US
Telephone Number	:	954-977-6636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	01/24/2019

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