MEDICARE: PASTORE-TRAN EYECARE, INC.

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	OPC3723	FL
2	152W00000X	Optometrist	OPC3769	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	:	1700979424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASTORE-TRAN EYECARE, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 560580
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32956-0580
Country	:	US
Telephone Number	:	321-693-4124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 US HIGHWAY 1
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2711
Country	:	US
Telephone Number	:	321-639-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACQUELINE TRAN
Credential	:	O.D.
Telephone Number	:	321-639-2020

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/15/2018

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