MEDICARE: CHARLES NUNEZ OD & ASSOCIATES 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

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	:	1174040083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES NUNEZ OD & ASSOCIATES PA

Provider Business Mailing Address
First Line	:	25 W COLLEGE AVE STE D
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-4701
Country	:	US
Telephone Number	:	18138862020
Fax Number	:	855-824-1872

Provider Business Practice Location Address
First Line	:	25 W COLLEGE AVE STE D
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-4701
Country	:	US
Telephone Number	:	813-886-2020
Fax Number	:	855-824-1872

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	CHARLES NUNEZ
Credential	:	OD
Telephone Number	:	813-886-2020

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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