MEDICARE: DR. BARBARA MANBURG O.D.

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	1763	FL

General Provider Information

NPI Number	:	1356370456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA MANBURG O.D.

Provider Business Mailing Address
First Line	:	3965 NW 53RD ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2705
Country	:	US
Telephone Number	:	561-997-9313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1670 S FEDERAL HWY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5030
Country	:	US
Telephone Number	:	561-279-2707
Fax Number	:	561-965-8525

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/08/2007

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