MEDICARE: SINCLAIR & CAMP, OD, PA

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	152WC0802X	Corneal and Contact Management Optometrist	OP02495	FL
2	152WP0200X	Pediatric Optometrist	OP02495	FL
3	152W00000X	Optometrist	OP02495	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	:	1760449623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SINCLAIR & CAMP, OD, PA

Provider Business Mailing Address
First Line	:	615 S ORANGE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-7503
Country	:	US
Telephone Number	:	941-366-2892
Fax Number	:	941-366-2893

Provider Business Practice Location Address
First Line	:	615 S ORANGE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-7503
Country	:	US
Telephone Number	:	941-366-2892
Fax Number	:	941-366-2893

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. LORI CAMP
Credential	:	OD
Telephone Number	:	941-366-2892

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	04/30/2009

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