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NPI Code Detail

MEDICARE: DR. EVA KAREN BOSWELL O.D.

MEDICARE: DR. EVA KAREN BOSWELL 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
1152W00000XOptometristOPC001799FL

General Provider Information

NPI Number : 1790827939
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EVA KAREN BOSWELL O.D.
Provider Business Mailing Address
First Line : 645 E LEMON AVE
Second Line :
City : LAKE ALFRED
State : FL
Zip : 33850-2225
Country : US
Telephone Number : 863-318-9966
Fax Number :
Provider Business Practice Location Address
First Line : 7450 CYPRESS GARDENS BLVD
Second Line : WAL-MART OPTICAL
City : WINTER HAVEN
State : FL
Zip : 33884-6200
Country : US
Telephone Number : 863-318-9966
Fax Number : 863-318-0348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 12/17/2013

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