MEDICARE: MERCY OPTICAL INC

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	174400000X	Specialist	OE 968	FL

General Provider Information

NPI Number	:	1487764403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY OPTICAL INC

Provider Business Mailing Address
First Line	:	2095 W 76TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1834
Country	:	US
Telephone Number	:	305-698-3030
Fax Number	:	305-698-3030

Provider Business Practice Location Address
First Line	:	2095 W 76TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1834
Country	:	US
Telephone Number	:	305-698-3030
Fax Number	:	305-698-3030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MERCEDES PADRON
Credential	:
Telephone Number	:	305-698-3030

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/16/2007

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Directions to “MERCY OPTICAL INC ” Practice Location

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