MEDICARE: TREASURE COAST EYE ASSOCIATES 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
1	152W00000X	Optometrist	OPC3612	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	:	1316098213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST EYE ASSOCIATES PA

Provider Business Mailing Address
First Line	:	333 17TH ST
Second Line	:	STE. G
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5670
Country	:	US
Telephone Number	:	772-978-0845
Fax Number	:	866-562-1117

Provider Business Practice Location Address
First Line	:	333 17TH ST
Second Line	:	STE. G
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5670
Country	:	US
Telephone Number	:	772-978-0845
Fax Number	:	866-562-1117

Authorized Official
Title or Position	:	OWNER OPTOMETRIST
Name	:	DR. BRICE A ROSELLI
Credential	:	O.D.
Telephone Number	:	772-978-0845

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/12/2007

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