MEDICARE: DR. TONY CARNEVALI 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	5827TPL	CA

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	:	1760479497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY CARNEVALI O.D.

Provider Business Mailing Address
First Line	:	3916 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-1307
Country	:	US
Telephone Number	:	323-234-9137
Fax Number	:	323-235-6203

Provider Business Practice Location Address
First Line	:	3916 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-1307
Country	:	US
Telephone Number	:	323-234-9137
Fax Number	:	323-235-6203

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	12/09/2010

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