Healthcare Provider Details

I. General information

NPI: 1134047475
Provider Name (Legal Business Name): ANNA MATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WICKHAM RD
MELBOURNE FL
32935-8937
US

IV. Provider business mailing address

7270 PINECREST AVE
MELBOURNE FL
32904-2452
US

V. Phone/Fax

Practice location:
  • Phone: 407-353-1475
  • Fax: 321-242-6718
Mailing address:
  • Phone: 407-353-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number6250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: