MEDICARE: MR. WENDELL SLONE DO

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	DO4347	FL

General Provider Information

NPI Number	:	1679798128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WENDELL SLONE DO

Provider Business Mailing Address
First Line	:	4530 PGA BLVD
Second Line	:	SUITE #105
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3912
Country	:	US
Telephone Number	:	561-622-1388
Fax Number	:	561-622-2408

Provider Business Practice Location Address
First Line	:	4530 PGA BLVD
Second Line	:	SUITE #105
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3912
Country	:	US
Telephone Number	:	561-622-1388
Fax Number	:	561-622-2408

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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