MEDICARE: KUBAL AND VEDULA OPHTHALMIC ASSOCIATES LLC

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	174400000X	Specialist	ME107368	FL

General Provider Information

NPI Number	:	1225316326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUBAL AND VEDULA OPHTHALMIC ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1776 N PINE ISLAND RD STE 214
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5223
Country	:	US
Telephone Number	:	954-452-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 N PINE ISLAND RD STE 214
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5223
Country	:	US
Telephone Number	:	954-452-9922
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANIL VEDULA
Credential	:	M.D.
Telephone Number	:	305-893-9201

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	06/16/2020

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