MEDICARE: SOUTH FLORIDA VISION SERVICES, INC.

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	:	1427704410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA VISION SERVICES, INC.

Provider Business Mailing Address
First Line	:	2900 W CYPRESS CREEK RD STE 4
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-1715
Country	:	US
Telephone Number	:	954-676-8446
Fax Number	:	954-979-2175

Provider Business Practice Location Address
First Line	:	6504 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6004
Country	:	US
Telephone Number	:	305-820-2033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT C. COPPOLA
Credential	:	OD
Telephone Number	:	954-676-8446

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	03/15/2022

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