MEDICARE: R & J NEBB, 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	OPC4357	FL
2	152W00000X	Optometrist	OPC4452	FL

General Provider Information

NPI Number	:	1710232350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R & J NEBB, O.D., P.A.

Provider Business Mailing Address
First Line	:	940 SWEETWATER LN
Second Line	:	#505
City	:	BOCA RATON
State	:	FL
Zip	:	33431-7132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 N STATE ROAD 7
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33073-3353
Country	:	US
Telephone Number	:	954-372-1301
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. JONATHAN NEBB
Credential	:	O.D.
Telephone Number	:	703-447-1644

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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