MEDICARE: DR. CANDICE NICOLE MANSITO 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	OPC5204	FL
2	152WC0802X	Corneal and Contact Management Optometrist	OPC5204	FL

General Provider Information

NPI Number	:	1730530056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE NICOLE MANSITO O.D.

Provider Business Mailing Address
First Line	:	2896 S EDGEHILL LN
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-3773
Country	:	US
Telephone Number	:	786-486-5228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1097 S LE JEUNE RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-2639
Country	:	US
Telephone Number	:	305-442-2020
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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