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General NPI Number Information
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NPI Number | 1629212006
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Entity Type | Organization
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Legal Business Name | DOMINICK A MARINO OD PA
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 4530 PGA BLVD SUITE105
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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 | 561-622-3671
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Fax | 561-622-5334
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Provider Business Mailing Address
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Address Line | 1983 JUNO ISLES BLVD
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-2422
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Country | US
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Telephone | 561-622-3671
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Fax | 561-622-5334
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Authorized Official
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Title or Position | PRESIDENT /OPTOMETRIST
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Name | DR. DOMINICK A MARINO
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Credential | OD
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Telephone | 561-799-2461
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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 | OPC 2073
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License Number State | FL
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