MEDICARE: AEG FLORIDA PROFESSIONAL PLLC

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	:	1598560880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEG FLORIDA PROFESSIONAL PLLC

Provider Business Mailing Address
First Line	:	111 E 4TH ST STE 440
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6206
Country	:	US
Telephone Number	:	314-741-8183
Fax Number	:

Provider Business Practice Location Address
First Line	:	7208 W SAND LAKE RD STE 202
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5278
Country	:	US
Telephone Number	:	407-271-8931
Fax Number	:

Authorized Official
Title or Position	:	SR. DIRECTOR MVC
Name	:	MELISSA ALLISON
Credential	:
Telephone Number	:	314-741-8183

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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Directions to “AEG FLORIDA PROFESSIONAL PLLC ” Practice Location

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