MEDICARE: DANIEL ANDREW AMYX OPTICIAN

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	1998	FL

General Provider Information

NPI Number	:	1811176696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ANDREW AMYX OPTICIAN

Provider Business Mailing Address
First Line	:	715 17TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6219
Country	:	US
Telephone Number	:	772-569-4288
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 17TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6219
Country	:	US
Telephone Number	:	772-569-4288
Fax Number	:

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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