MEDICARE: FAMILY VISION CENTER 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	152W00000X	Optometrist	2875	FL

General Provider Information

NPI Number	:	1336289529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY VISION CENTER P.A.

Provider Business Mailing Address
First Line	:	6802 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3353
Country	:	US
Telephone Number	:	561-439-2020
Fax Number	:	561-642-0445

Provider Business Practice Location Address
First Line	:	6802 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3353
Country	:	US
Telephone Number	:	561-439-2020
Fax Number	:	561-642-0445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LORI ANN MAZZA
Credential	:	O.D.
Telephone Number	:	561-439-2020

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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