MEDICARE: PROFESSIONAL FAMILY EYECARE, 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	152W00000X	Optometrist	OPC2912	FL

General Provider Information

NPI Number	:	1518282862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL FAMILY EYECARE, INC

Provider Business Mailing Address
First Line	:	137 S STATE ROAD 7
Second Line	:	SUITE 303
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33414-4380
Country	:	US
Telephone Number	:	561-798-7432
Fax Number	:	561-791-4430

Provider Business Practice Location Address
First Line	:	137 S STATE ROAD 7
Second Line	:	SUITE 303
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33414-4380
Country	:	US
Telephone Number	:	561-798-7432
Fax Number	:	561-791-4430

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. JOLENE ANN REITER
Credential	:	OD
Telephone Number	:	561-798-7432

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	11/21/2013

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