MEDICARE: KERI MARIE POMELLA 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	OPC3040	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316978364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERI MARIE POMELLA OD

Provider Business Mailing Address
First Line	:	1550 W 84TH ST STE 15
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3368
Country	:	US
Telephone Number	:	305-556-6946
Fax Number	:	305-602-8153

Provider Business Practice Location Address
First Line	:	1550 W 84TH ST STE 14
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3368
Country	:	US
Telephone Number	:	305-556-6946
Fax Number	:	305-602-8153

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/24/2020

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