MEDICARE: MRS. JENNIFER MYLES IANNARELLI 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	OPC3926	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

General Provider Information

NPI Number	:	1902879554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MYLES IANNARELLI O.D.

Provider Business Mailing Address
First Line	:	1400 HAND AVE STE N
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8196
Country	:	US
Telephone Number	:	386-872-3111
Fax Number	:	386-872-3190

Provider Business Practice Location Address
First Line	:	1400 HAND AVE STE N
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8196
Country	:	US
Telephone Number	:	386-872-3111
Fax Number	:	386-872-3190

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/28/2021

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