MEDICARE: DOC VISION EYE CARE CENTERS, LLC

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	305S00000X	Point of Service	DO 6199	FL

General Provider Information

NPI Number	:	1790105963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOC VISION EYE CARE CENTERS, LLC

Provider Business Mailing Address
First Line	:	19421 SHERIDAN ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33332-1653
Country	:	US
Telephone Number	:	954-621-1321
Fax Number	:	954-213-6266

Provider Business Practice Location Address
First Line	:	19421 SHERIDAN ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33332-1653
Country	:	US
Telephone Number	:	954-621-1321
Fax Number	:	954-213-6266

Authorized Official
Title or Position	:	MGR
Name	:	MR. DARPAN SHARMA
Credential	:
Telephone Number	:	954-621-1321

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	04/25/2014

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