MEDICARE: AMELIA ISLAND DOCTORS OF OPTOMETRY

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	OPC5182	FL

General Provider Information

NPI Number	:	1306297726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMELIA ISLAND DOCTORS OF OPTOMETRY

Provider Business Mailing Address
First Line	:	1523 SADLER RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4467
Country	:	US
Telephone Number	:	904-647-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 SADLER RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4467
Country	:	US
Telephone Number	:	904-647-4224
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERALD SUNKIN
Credential	:	OD
Telephone Number	:	330-338-9067

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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