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NPI Code Detail

MEDICARE: MANATEE FAMILY EYECARE, PA

MEDICARE: MANATEE FAMILY EYECARE, 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
1152W00000XOptometrist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DC7823OTHERFLGBA-RAILROAD MEDICARE

General Provider Information

NPI Number : 1215111547
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANATEE FAMILY EYECARE, PA
Provider Business Mailing Address
First Line : 501 VILLAGE GREEN PKWY STE 3
Second Line :
City : BRADENTON
State : FL
Zip : 34209-3401
Country : US
Telephone Number : 941-792-7522
Fax Number :
Provider Business Practice Location Address
First Line : 1236 JACARANDA BLVD
Second Line :
City : VENICE
State : FL
Zip : 34292-4507
Country : US
Telephone Number : 941-496-4444
Fax Number : 941-496-4223
Authorized Official
Title or Position : VICE PRESIDENT
Name : WARREN A PAQUIN JR.
Credential : OD
Telephone Number : 941-729-5516
Provider Enumeration Date : 12/21/2007
Last Update Date : 07/25/2023

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1689944589 — ELLEN P SKEELS PT
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Directions to “MANATEE FAMILY EYECARE, PA ” Practice Location

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