MEDICARE: TREASURE COAST OPTICAL, INC.

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-3420	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306046925	OTHER	FL	NPI

General Provider Information

NPI Number	:	1629361902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST OPTICAL, INC.

Provider Business Mailing Address
First Line	:	1331 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5331
Country	:	US
Telephone Number	:	772-398-4500
Fax Number	:	772-398-4502

Provider Business Practice Location Address
First Line	:	1331 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5331
Country	:	US
Telephone Number	:	772-398-4500
Fax Number	:	772-398-4502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TARI SCHMIT
Credential	:	O.D.
Telephone Number	:	772-398-4500

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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