MEDICARE: SERENITY EYE CARE PC

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	0618002027	VA

General Provider Information

NPI Number	:	1538459532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY EYE CARE PC

Provider Business Mailing Address
First Line	:	8853 WOODGROVE RIDGE CT
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4872
Country	:	US
Telephone Number	:	964-593-0902
Fax Number	:

Provider Business Practice Location Address
First Line	:	8853 WOODGROVE RIDGE CT
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4872
Country	:	US
Telephone Number	:	964-593-0902
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TERRI-ANN BAILEY ECHAGUE
Credential	:	O.D.
Telephone Number	:	954-593-0902

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	02/23/2022

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