MEDICARE: DR. BARRY S PIVNICK 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	667	CT

General Provider Information

NPI Number	:	1649304775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY S PIVNICK O.D.

Provider Business Mailing Address
First Line	:	6712 SOUTHPORT DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6921
Country	:	US
Telephone Number	:	561-737-8183
Fax Number	:

Provider Business Practice Location Address
First Line	:	6712 SOUTHPORT DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6921
Country	:	US
Telephone Number	:	561-737-8183
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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