MEDICARE: C&D EYE CARE PA

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	OPC4035	FL

General Provider Information

NPI Number	:	1093776221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C&D EYE CARE PA

Provider Business Mailing Address
First Line	:	4125 CLEVELAND AVE
Second Line	:	SEARS OPTICAL STE 88
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9046
Country	:	US
Telephone Number	:	239-693-3937
Fax Number	:	239-939-3664

Provider Business Practice Location Address
First Line	:	4125 CLEVELAND AVE
Second Line	:	SEARS OPTICAL STE 88
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9046
Country	:	US
Telephone Number	:	239-693-3937
Fax Number	:	239-939-3664

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONNA JOY MANGATT
Credential	:	OD
Telephone Number	:	954-383-6944

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	01/07/2009

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