MEDICARE: CORAL SPRINGS VISION CARE PLLC

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	OPC 3853	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FM674A	OTHER		MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346564325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL SPRINGS VISION CARE PLLC

Provider Business Mailing Address
First Line	:	9773 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4003
Country	:	US
Telephone Number	:	954-753-0137
Fax Number	:	954-753-0139

Provider Business Practice Location Address
First Line	:	9773 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4003
Country	:	US
Telephone Number	:	954-753-0137
Fax Number	:	954-753-0139

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	DR. KATHERINE ORELLANA-MEDINA
Credential	:	O.D.
Telephone Number	:	954-753-0137

Provider Enumeration Date	:	03/20/2010
Last Update Date	:	10/30/2013

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