MEDICARE: EDWARD M MENDELSOHN

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	156FX1800X	Optician	1431	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457436818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD M MENDELSOHN

Provider Business Mailing Address
First Line	:	4830 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4606
Country	:	US
Telephone Number	:	954-491-0530
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4606
Country	:	US
Telephone Number	:	954-491-0530
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/08/2008

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Directions to “ EDWARD M MENDELSOHN ” Practice Location

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