MEDICARE: IVANKA ACOSTA OD

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	6378	FL

General Provider Information

NPI Number	:	1972377612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANKA ACOSTA OD

Provider Business Mailing Address
First Line	:	3940 NW 79TH AVE APT 307
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33166-6581
Country	:	US
Telephone Number	:	305-748-5185
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5502
Country	:	US
Telephone Number	:	305-554-0693
Fax Number	:

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

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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