MEDICARE: PAMELA EBMEIER MONTMENY O D P A

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	OPC2585	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	FP779A	OTHER	FL	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3920370001	OTHER	FL	DME
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659680759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA EBMEIER MONTMENY O D P A

Provider Business Mailing Address
First Line	:	2641 E OAKLAND PARK BLVD
Second Line	:	SUITE 3
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1665
Country	:	US
Telephone Number	:	954-563-3211
Fax Number	:	954-563-3919

Provider Business Practice Location Address
First Line	:	2641 E OAKLAND PARK BLVD
Second Line	:	SUITE 3
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1665
Country	:	US
Telephone Number	:	954-563-3211
Fax Number	:	954-563-3919

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAMELA EBMEIER
Credential	:	O.D.
Telephone Number	:	954-563-2211

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	02/03/2014

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Directions to “PAMELA EBMEIER MONTMENY O D P A ” Practice Location

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