MEDICARE: KARLA FLORES MACIAS

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	6555	FL

General Provider Information

NPI Number	:	1124868237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA FLORES MACIAS

Provider Business Mailing Address
First Line	:	941 PALM DR
Second Line	:
City	:	BELLEAIR BEACH
State	:	FL
Zip	:	33786-3341
Country	:	US
Telephone Number	:	314-556-0296
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4298
Country	:	US
Telephone Number	:	727-443-6493
Fax Number	:

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	08/27/2024

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