MEDICARE: MR. DOUGLAS JOHN MACHIELA OD

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	OPC2245	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700879046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS JOHN MACHIELA OD

Provider Business Mailing Address
First Line	:	3704 VALLEY PARK WAY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2333
Country	:	US
Telephone Number	:	561-641-5741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5493 10TH AVE N
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-2056
Country	:	US
Telephone Number	:	561-439-0075
Fax Number	:	561-439-0413

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/27/2010

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