MEDICARE: DR. ANN AWADALLA 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	5803	FL

General Provider Information

NPI Number	:	1467070391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN AWADALLA OD

Provider Business Mailing Address
First Line	:	313 QUAIL HUNT RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6590
Country	:	US
Telephone Number	:	864-787-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 BELVEDERE RD STE 1
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1243
Country	:	US
Telephone Number	:	561-832-0677
Fax Number	:

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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