MEDICARE: ZEANA BIANCA BERTACCHI 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	5843	OH

General Provider Information

NPI Number	:	1619200789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZEANA BIANCA BERTACCHI O.D.

Provider Business Mailing Address
First Line	:	26800 AMHEARST CIR
Second Line	:	#304
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7570
Country	:	US
Telephone Number	:	847-648-6361
Fax Number	:

Provider Business Practice Location Address
First Line	:	691 RICHMOND RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-2990
Country	:	US
Telephone Number	:	440-461-1860
Fax Number	:

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

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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