MEDICARE: DANIELE JEAN OPTOMETRY 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

General Provider Information

NPI Number	:	1700432804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELE JEAN OPTOMETRY PA

Provider Business Mailing Address
First Line	:	DANIELE JEAN
Second Line	:	9700 VINEYARD CT
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4347
Country	:	US
Telephone Number	:	954-864-0930
Fax Number	:

Provider Business Practice Location Address
First Line	:	6976 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3302
Country	:	US
Telephone Number	:	954-227-2770
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIELE JEAN
Credential	:	OD
Telephone Number	:	954-864-0930

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	08/14/2019

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