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NPI Code Detail

MEDICARE: 20/20 CLUB

MEDICARE: 20/20 CLUB
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
1152W00000XOptometristOPC 4365FL

General Provider Information

NPI Number : 1790922813
Entity Type Code : Organization
Provider Name (Legal Business Name) : 20/20 CLUB
Provider Business Mailing Address
First Line : 10155 OKEECHOBEE BLVD
Second Line : OPTICAL
City : ROYAL PALM BEACH
State : FL
Zip : 33411-1404
Country : US
Telephone Number : 516-784-2778
Fax Number : 561-798-9409
Provider Business Practice Location Address
First Line : 10155 OKEECHOBEE BLVD
Second Line : OPTICAL
City : ROYAL PALM BEACH
State : FL
Zip : 33411-1404
Country : US
Telephone Number : 516-784-2778
Fax Number : 561-798-9409
Authorized Official
Title or Position : MANAGER
Name : DR. MICHAEL JOE NODLAND
Credential : O.D.
Telephone Number : 561-784-2778
Provider Enumeration Date : 01/12/2009
Last Update Date : 01/12/2009

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Directions to “20/20 CLUB ” Practice Location

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