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General NPI Number Information
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NPI Number | 1407875321
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Entity Type | Individual
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Provider Name | DOMINICK ANTHONY MARINO O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 4530 PGA BLVD SUITE 105
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-3912
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Country | US
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Telephone | 561-799-2461
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Fax | 561-622-2408
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Provider Business Mailing Address
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Address Line | 10887 N MILITARY TRL STE 3
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-6528
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Country | US
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Telephone | 561-799-2461
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Fax | 561-622-2408
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OP0002073
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License Number State | FL
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