MEDICARE: DOMINICK A MARINO OD PA

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	OPC 2073	FL

General Provider Information

NPI Number	:	1629212006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINICK A MARINO OD PA

Provider Business Mailing Address
First Line	:	1983 JUNO ISLES BLVD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-2422
Country	:	US
Telephone Number	:	561-622-3671
Fax Number	:	561-622-5334

Provider Business Practice Location Address
First Line	:	4530 PGA BLVD
Second Line	:	SUITE105
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3912
Country	:	US
Telephone Number	:	561-622-3671
Fax Number	:	561-622-5334

Authorized Official
Title or Position	:	PRESIDENT /OPTOMETRIST
Name	:	DR. DOMINICK A MARINO
Credential	:	OD
Telephone Number	:	561-799-2461

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	03/29/2010

Similar Medicare Providers

1407875321 — DR. DOMINICK ANTHONY MARINO O.D.
Practice Location Address:

4530 PGA BLVD , SUITE 105
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1073122214 — YARIDYS GALLARDO
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