MEDICARE: DR. RENEE J GAROFALO 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
1	152W00000X	Optometrist	3634-TG	TX

General Provider Information

NPI Number	:	1972929727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE J GAROFALO O.D.

Provider Business Mailing Address
First Line	:	6300 GREENBRIAR LANE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-751-9321
Fax Number	:	817-615-4602

Provider Business Practice Location Address
First Line	:	6201 S. FREEWAY, TC-44
Second Line	:	ALCON RESEARCH, LTD.
City	:	FORT WORTH
State	:	TX
Zip	:	76134-2099
Country	:	US
Telephone Number	:	817-615-2712
Fax Number	:	817-615-4602

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

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	01/06/2017

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