MEDICARE: PRIMARY EYE CARE OF FLORIDA, 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	OPC3811	FL

General Provider Information

NPI Number	:	1902134612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY EYE CARE OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	7442 TRANSOM CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5870
Country	:	US
Telephone Number	:	727-846-6235
Fax Number	:

Provider Business Practice Location Address
First Line	:	9409 US HIGHWAY 19 STE 101
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4626
Country	:	US
Telephone Number	:	727-846-6235
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. RIZ JUAN KHAN
Credential	:	OD
Telephone Number	:	407-401-0530

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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