MEDICARE: MR. SERAPIO CEPERO L.D.O.

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	156FX1800X	Optician	DO624	FL

General Provider Information

NPI Number	:	1770701732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SERAPIO CEPERO L.D.O.

Provider Business Mailing Address
First Line	:	1705 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-2728
Country	:	US
Telephone Number	:	305-858-4057
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-2728
Country	:	US
Telephone Number	:	305-858-4057
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/09/2007

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