MEDICARE: DR. MICHAEL RYAN OBREGON O.D

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	OPC 2089	FL

General Provider Information

NPI Number	:	1578551123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RYAN OBREGON O.D

Provider Business Mailing Address
First Line	:	441 NE 101ST ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2448
Country	:	US
Telephone Number	:	305-527-0098
Fax Number	:

Provider Business Practice Location Address
First Line	:	2726 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6005
Country	:	US
Telephone Number	:	305-444-9600
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	09/09/2009

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