MEDICARE: MARCIANO FAMILY OPTOMETRIC

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	OPC 003248	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5446497	OTHER	FL	CIGNA
2	20844	OTHER	FL	BLUE CROSS & BLUE SHIELD
3	002368580	OTHER	FL	UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447325568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCIANO FAMILY OPTOMETRIC

Provider Business Mailing Address
First Line	:	1788 N. JOG RD.
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-0000
Country	:	US
Telephone Number	:	561-242-1200
Fax Number	:	561-242-1291

Provider Business Practice Location Address
First Line	:	1788 N. JOG RD.
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-0000
Country	:	US
Telephone Number	:	561-242-1200
Fax Number	:	561-242-1291

Authorized Official
Title or Position	:	OPTOMETRIST-OWNER
Name	:	DR. MARK THOMAS MARCIANO
Credential	:	O.D.
Telephone Number	:	561-242-1200

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	03/27/2015

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