MEDICARE: EYE DEAL VISION LLC

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 2752	FL

General Provider Information

NPI Number	:	1669855722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE DEAL VISION LLC

Provider Business Mailing Address
First Line	:	6641 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3527
Country	:	US
Telephone Number	:	561-738-0112
Fax Number	:

Provider Business Practice Location Address
First Line	:	7092 BRUNSWICK CIR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2533
Country	:	US
Telephone Number	:	561-252-2558
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ROSALYN MISDRAJI
Credential	:	OD
Telephone Number	:	561-738-0112

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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