MEDICARE: J. LOUIS KORMAN 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	OPC2537	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	939468	OTHER	FL	EYEMED

General Provider Information

NPI Number	:	1265627814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J. LOUIS KORMAN O.D.

Provider Business Mailing Address
First Line	:	11891 ROYAL PALM BLVD
Second Line	:	APT. 203
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-7374
Country	:	US
Telephone Number	:	954-344-8127
Fax Number	:

Provider Business Practice Location Address
First Line	:	12055 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-4112
Country	:	US
Telephone Number	:	954-392-5450
Fax Number	:	954-431-0745

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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