MEDICARE: DR. BLYTHE C. PENA 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	6473	FL

General Provider Information

NPI Number	:	1013758580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLYTHE C. PENA OD

Provider Business Mailing Address
First Line	:	900 E ATLANTIC AVE STE 17
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6954
Country	:	US
Telephone Number	:	561-265-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E ATLANTIC AVE STE 17
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6954
Country	:	US
Telephone Number	:	561-265-2020
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/15/2026

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