MEDICARE: EYES OF PALM HARBOR

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	156FX1800X	Optician	DO2953	FL

General Provider Information

NPI Number	:	1053596619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES OF PALM HARBOR

Provider Business Mailing Address
First Line	:	36163 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-787-2645
Fax Number	:	727-787-2680

Provider Business Practice Location Address
First Line	:	36163 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-787-2645
Fax Number	:	727-787-2680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NANCY HAMMER
Credential	:	DISPENSING OPTICIAN
Telephone Number	:	17277872645

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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Directions to “EYES OF PALM HARBOR ” Practice Location

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