MEDICARE: PROFESSIONAL VISION CARE, P.C.

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

General Provider Information

NPI Number	:	1538281332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL VISION CARE, P.C.

Provider Business Mailing Address
First Line	:	2900 W CYPRESS CREEK RD
Second Line	:	SUITE 4
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1715
Country	:	US
Telephone Number	:	954-917-2337
Fax Number	:	954-917-2919

Provider Business Practice Location Address
First Line	:	3331 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4042
Country	:	US
Telephone Number	:	210-276-0154
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROBERT COPPOLA
Credential	:
Telephone Number	:	954-917-2337

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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