MEDICARE: CAPE CORAL EYE CENTER, P.A.

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

General Provider Information

NPI Number	:	1912221383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CORAL EYE CENTER, P.A.

Provider Business Mailing Address
First Line	:	P.O. BOX 101427
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33910-1427
Country	:	US
Telephone Number	:	239-540-8718
Fax Number	:	239-945-0847

Provider Business Practice Location Address
First Line	:	5781 BAYSHORE RD
Second Line	:	SUITE 101
City	:	N FORT MYERS
State	:	FL
Zip	:	33917-3003
Country	:	US
Telephone Number	:	239-542-2020
Fax Number	:	239-567-5260

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JENNIFER GALLO
Credential	:	OD
Telephone Number	:	239-542-2020

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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