MEDICARE: KARIENE N YZENAS

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	1030	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4338690001	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1427227289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIENE N YZENAS

Provider Business Mailing Address
First Line	:	1219 S EAST AVE STE 107
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2351
Country	:	US
Telephone Number	:	941-365-4040
Fax Number	:	941-365-3957

Provider Business Practice Location Address
First Line	:	1219 S EAST AVE STE 107
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2351
Country	:	US
Telephone Number	:	941-365-4040
Fax Number	:	941-365-3957

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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