MEDICARE: DR. LENWARD MCCALLA 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	152WC0802X	Corneal and Contact Management Optometrist	2077	FL

General Provider Information

NPI Number	:	1649300724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LENWARD MCCALLA O.D.

Provider Business Mailing Address
First Line	:	15141 SW 159TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6601
Country	:	US
Telephone Number	:	305-378-1915
Fax Number	:	305-256-6919

Provider Business Practice Location Address
First Line	:	11417 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-4443
Country	:	US
Telephone Number	:	305-378-1915
Fax Number	:	305-256-6919

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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