MEDICARE: FORT LAUDERDALE EYE CARE AND EYEWEAR, 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	152W00000X	Optometrist	OPC2885	FL

General Provider Information

NPI Number	:	1306154588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT LAUDERDALE EYE CARE AND EYEWEAR, LLC

Provider Business Mailing Address
First Line	:	209 N FORT LAUDERDALE BEACH BLVD
Second Line	:	UNIT 11G
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-4365
Country	:	US
Telephone Number	:	954-303-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1489 SE 17TH ST
Second Line	:	SUITE 2J
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1734
Country	:	US
Telephone Number	:	954-763-2842
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAWN BEARDEN
Credential	:	O.D.
Telephone Number	:	954-303-6600

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	10/03/2011

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