MEDICARE: MILENA OPACIC

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	OPC6293	FL

General Provider Information

NPI Number	:	1346929866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILENA OPACIC

Provider Business Mailing Address
First Line	:	11918 SW COMMUNITY BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-6709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 NW SAINT LUCIE WEST BLVD STE 184
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2521
Country	:	US
Telephone Number	:	772-924-3700
Fax Number	:

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

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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