MEDICARE: DR. DOMINICK ANTHONY MARINO 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	OP0002073	FL

General Provider Information

NPI Number	:	1407875321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINICK ANTHONY MARINO O.D.

Provider Business Mailing Address
First Line	:	10887 N MILITARY TRL
Second Line	:	STE 3
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6528
Country	:	US
Telephone Number	:	561-799-2461
Fax Number	:	561-622-2408

Provider Business Practice Location Address
First Line	:	4530 PGA BLVD
Second Line	:	SUITE 105
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3912
Country	:	US
Telephone Number	:	561-799-2461
Fax Number	:	561-622-2408

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/17/2019

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