MEDICARE: ROBERT V DADDARIO 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	152W00000X	Optometrist	OPC2507	FL

General Provider Information

NPI Number	:	1437154788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT V DADDARIO OD

Provider Business Mailing Address
First Line	:	1191 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4520
Country	:	US
Telephone Number	:	941-493-0311
Fax Number	:	941-492-4655

Provider Business Practice Location Address
First Line	:	1219 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4520
Country	:	US
Telephone Number	:	941-493-0311
Fax Number	:	941-492-4655

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/17/2019

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