MEDICARE: PASADENA EYE CENTER, 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	332H00000X	Eyewear Supplier

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5451200001	OTHER	FL	MEDICARE DME

General Provider Information

NPI Number	:	1891024428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA EYE CENTER, LLC

Provider Business Mailing Address
First Line	:	6950 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1210
Country	:	US
Telephone Number	:	727-343-3004
Fax Number	:	727-343-9521

Provider Business Practice Location Address
First Line	:	6950 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1210
Country	:	US
Telephone Number	:	727-343-3004
Fax Number	:	727-343-9521

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DAVID E HALL
Credential	:	M.D.
Telephone Number	:	727-343-3004

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/10/2009

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Directions to “PASADENA EYE CENTER, LLC ” Practice Location

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