MEDICARE: EVANS EYE CARE CORP

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

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	:	1255815064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS EYE CARE CORP

Provider Business Mailing Address
First Line	:	235 NW 207TH TER
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-3506
Country	:	US
Telephone Number	:	302-670-4096
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4732
Country	:	US
Telephone Number	:	302-670-4096
Fax Number	:	305-949-7301

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. SHANNON EVANS
Credential	:	OD
Telephone Number	:	302-670-4096

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	10/24/2018

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Directions to “EVANS EYE CARE CORP ” Practice Location

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