MEDICARE: VANESSA LUCIA GAGLIANO OD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	6135	FL

General Provider Information

NPI Number	:	1417687674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA LUCIA GAGLIANO OD

Provider Business Mailing Address
First Line	:	1980 S OCEAN DR APT 8J
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5935
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6448 PEMBROKE RD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2138
Country	:	US
Telephone Number	:	954-431-2020
Fax Number	:

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

Provider Enumeration Date	:	06/12/2022
Last Update Date	:	08/12/2022

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