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NPI Code Detail

MEDICARE: PALM BEACH EYE DOCTOR INC

MEDICARE: PALM BEACH EYE DOCTOR 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1639664956
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALM BEACH EYE DOCTOR INC
Provider Business Mailing Address
First Line : 295 QUEENS CT
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-7323
Country : US
Telephone Number : 561-784-2778
Fax Number : 561-798-9409
Provider Business Practice Location Address
First Line : 10155 OKEECHOBEE BLVD
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-1404
Country : US
Telephone Number : 561-784-2778
Fax Number : 561-798-9409
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL J NODLAND
Credential : OD
Telephone Number : 561-784-2778
Provider Enumeration Date : 06/28/2018
Last Update Date : 06/28/2018

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Directions to “PALM BEACH EYE DOCTOR INC ” Practice Location

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