MEDICARE: DR. LORI ANN MAZZA 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	OPC0002875	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154393098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI ANN MAZZA O.D.

Provider Business Mailing Address
First Line	:	6802 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3353
Country	:	US
Telephone Number	:	561-439-2020
Fax Number	:	561-642-0445

Provider Business Practice Location Address
First Line	:	6802 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3353
Country	:	US
Telephone Number	:	561-439-2020
Fax Number	:	561-642-0445

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

Provider Enumeration Date	:	02/04/2006
Last Update Date	:	07/21/2010

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