MEDICARE: DEBBIE FELISHA ALI 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	OPC5271	FL
2	152W00000X	Optometrist	8398	NY

General Provider Information

NPI Number	:	1669929204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE FELISHA ALI O.D

Provider Business Mailing Address
First Line	:	5730 SW 54TH AVENUE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11645 BISCAYNE BLVD STE 207
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3138
Country	:	US
Telephone Number	:	305-538-8835
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/18/2018

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