MEDICARE: MR. MICHAEL D CONTE 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	03120T	TX
2	152WV0400X	Vision Therapy Optometrist	03120T	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1851580351	OTHER	TX	MEDICARE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	81282Q	OTHER	TX	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1417951179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL D CONTE O.D.

Provider Business Mailing Address
First Line	:	6636 LAKE WORTH BLVD
Second Line	:	SIUTE 300
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3026
Country	:	US
Telephone Number	:	817-626-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	6636 LAKE WORTH BLVD
Second Line	:	SIUTE 300
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3026
Country	:	US
Telephone Number	:	817-626-4441
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/28/2009

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