MEDICARE: DOUGLAS J. MACHIELA O.D.P.A.

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	332H00000X	Eyewear Supplier	OPC2245	FL

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	:	1285892992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS J. MACHIELA O.D.P.A.

Provider Business Mailing Address
First Line	:	5493 10TH AVE N
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-2056
Country	:	US
Telephone Number	:	561-439-0075
Fax Number	:	561-439-0413

Provider Business Practice Location Address
First Line	:	5493 10TH AVE N
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-2056
Country	:	US
Telephone Number	:	561-439-0075
Fax Number	:	561-439-0413

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS J. MACHIELA
Credential	:	O.D.
Telephone Number	:	561-439-0075

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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