MEDICARE: DR. MARK J. SARNO 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	OPC1514	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861491144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. SARNO O.D.

Provider Business Mailing Address
First Line	:	8250 BRYAN DAIRY RD STE 120
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33777-1357
Country	:	US
Telephone Number	:	727-489-0500
Fax Number	:	727-489-0508

Provider Business Practice Location Address
First Line	:	10785 102ND AVE
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33778-4211
Country	:	US
Telephone Number	:	727-209-3937
Fax Number	:	727-394-7393

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	02/15/2012

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