MEDICARE: DR. MICHAEL F POLO 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	0618002492	VA

General Provider Information

NPI Number	:	1588011738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL F POLO O.D.

Provider Business Mailing Address
First Line	:	3731 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1346
Country	:	US
Telephone Number	:	804-526-3676
Fax Number	:	804-520-5781

Provider Business Practice Location Address
First Line	:	3731 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1346
Country	:	US
Telephone Number	:	804-526-3676
Fax Number	:	804-520-5781

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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