MEDICARE: CAPE CORAL EYE CENTER, P.A.

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	OPC3656	FL

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	:	1629392261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CORAL EYE CENTER, P.A.

Provider Business Mailing Address
First Line	:	P.O. BOX 101427
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33910
Country	:	US
Telephone Number	:	239-540-8718
Fax Number	:	239-945-0847

Provider Business Practice Location Address
First Line	:	4085 HANCOCK BRIDGE PKWY
Second Line	:	SUITE 120
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-7219
Country	:	US
Telephone Number	:	239-542-2020
Fax Number	:	239-567-5248

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JENNIFER GALLO
Credential	:	OD
Telephone Number	:	239-542-2020

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/25/2010

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