MEDICARE: M.Y. VISION OPTOMETRY LLC

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	:	1891335493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.Y. VISION OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	2223 N WEST SHORE BLVD STE 280
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-7228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 N WEST SHORE BLVD STE 280
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-7228
Country	:	US
Telephone Number	:	813-690-9372
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARYANN YOUSSEF
Credential	:	OD
Telephone Number	:	407-902-8792

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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