MEDICARE: EYETRUST VISION

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	OPC 4514	FL

General Provider Information

NPI Number	:	1033487988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYETRUST VISION

Provider Business Mailing Address
First Line	:	1201 BRICKELL AVE
Second Line	:	300
City	:	MIAMI
State	:	FL
Zip	:	33131-3207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 BRICKELL AVE
Second Line	:	300
City	:	MIAMI
State	:	FL
Zip	:	33131-3207
Country	:	US
Telephone Number	:	305-587-9898
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW CHRYCY
Credential	:
Telephone Number	:	305-587-9898

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	08/13/2013

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Directions to “EYETRUST VISION ” Practice Location

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