MEDICARE: DR. MARISSA NICOTRA-BARNES OD

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	OPC6163	FL

General Provider Information

NPI Number	:	1295461879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA NICOTRA-BARNES OD

Provider Business Mailing Address
First Line	:	1500 BEVILLE RD
Second Line	:	STE 606 MAILBOX 369
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114
Country	:	US
Telephone Number	:	386-214-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	5517 S WILLIAMSON BLVD STE 310
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-8310
Country	:	US
Telephone Number	:	386-322-4304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	04/14/2025

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