MEDICARE: ADVANCED EYE CARE OF HIALEAH, PA

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	3040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023111036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED EYE CARE OF HIALEAH, PA

Provider Business Mailing Address
First Line	:	5952 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6814
Country	:	US
Telephone Number	:	305-556-6946
Fax Number	:	305-825-0845

Provider Business Practice Location Address
First Line	:	5952 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6814
Country	:	US
Telephone Number	:	305-556-6946
Fax Number	:	305-825-0845

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KERI MARIE POMELLA
Credential	:	OD
Telephone Number	:	305-556-6946

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/16/2011

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