MEDICARE: THE WIZARD OF EYES OF S FL INC

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	156FX1800X	Optician	DO5743	FL

General Provider Information

NPI Number	:	1184757296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WIZARD OF EYES OF S FL INC

Provider Business Mailing Address
First Line	:	7107 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2906
Country	:	US
Telephone Number	:	561-966-2212
Fax Number	:	561-966-2215

Provider Business Practice Location Address
First Line	:	7107 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2906
Country	:	US
Telephone Number	:	561-966-2212
Fax Number	:	561-966-2215

Authorized Official
Title or Position	:	SECRETARY
Name	:	MARCI ANZALONE
Credential	:
Telephone Number	:	561-966-2212

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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