MEDICARE: FAMILY VISION ASSOCIATES, P.A.

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	OPC002181	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
2	19389	OTHER	FL	BLUE CROSS & BLUE SHIELD OF FLORIDA

General Provider Information

NPI Number	:	1043478704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY VISION ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	11380 PROSPERITY FARMS RD
Second Line	:	SUITE 119
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3464
Country	:	US
Telephone Number	:	561-627-1114
Fax Number	:	561-627-2304

Provider Business Practice Location Address
First Line	:	11380 PROSPERITY FARMS RD
Second Line	:	SUITE 119
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3464
Country	:	US
Telephone Number	:	561-627-1114
Fax Number	:	561-627-2304

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL B HAUGEN
Credential	:	O.D.
Telephone Number	:	561-627-1114

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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