MEDICARE: EYE OF HORUS 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	207W00000X	Ophthalmology Physician	ME 93252	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DE5206	OTHER	FL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7456729	OTHER	FL	AETNA
3	08-00553	OTHER	FL	UNITED HEALTH CARE
4	63665	OTHER	FL	GREAT WEST HEALTH CARE
5	PCS1492	OTHER	FL	PARTNER CARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164421418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE OF HORUS PA

Provider Business Mailing Address
First Line	:	9325 GLADES ROAD
Second Line	:	SUITE 201
City	:	BOCA RATON
State	:	FL
Zip	:	33434-3405
Country	:	US
Telephone Number	:	561-488-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	9325 GLADES RD
Second Line	:	SUITE 201
City	:	BOCA RATON
State	:	FL
Zip	:	33434-3907
Country	:	US
Telephone Number	:	561-488-1001
Fax Number	:

Authorized Official
Title or Position	:	CEO, WEST BOCA EYE CENTER
Name	:	DR. BRENT BELLOTTE
Credential	:	M.D.
Telephone Number	:	561-488-1001

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	01/24/2012

Similar Medicare Providers

1053310391 — DR. RANYA GEORGIA HABASH M.D.
Practice Location Address:

9325 GLADES RD , SUITE 201
BOCA RATON, FL
33434-3907

Practice Phone: 561-488-1001
Practice Fax:

1942209283 — DR. BRENT WILLIAM BELLOTTE M.D.
Practice Location Address:

9325 GLADES RD , SUITE 201
BOCA RATON, FL
33434-3907

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1043260391 — DR. RONALD LARACUENTE M.D.
Practice Location Address:

9325 GLADES RD , SUITE 204
BOCA RATON, FL
33434-3907

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1063466159 — DR. ROBERT BRADLEY ROWEN DMD
Practice Location Address:

9325 GLADES RD , #106
BOCA RATON, FL
33434-3907

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Practice Fax:

1831139351 — DR. SCOTT DUDAK M.D.
Practice Location Address:

9325 GLADES RD , SUITE 101
BOCA RATON, FL
33434-3907

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1245177690 — PATRICIA KEATING
Practice Location Address:

2575 NW 27TH ST
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Directions to “EYE OF HORUS PA ” Practice Location

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