MEDICARE: TUCKER EYE-EXAM & CONTACT LENS CENTER

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	FL OPC #1977	FL

General Provider Information

NPI Number	:	1932424496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCKER EYE-EXAM & CONTACT LENS CENTER

Provider Business Mailing Address
First Line	:	3955 HUNTERS RIDGE WAY
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-1855
Country	:	US
Telephone Number	:	352-361-5202
Fax Number	:	800-878-9609

Provider Business Practice Location Address
First Line	:	12950 E COLONIAL DR
Second Line	:	SUITE # 100
City	:	ORLANDO
State	:	FL
Zip	:	32826-4609
Country	:	US
Telephone Number	:	352-361-5205
Fax Number	:	800-878-9609

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MARIANN LOUISE TUCKER
Credential	:	O.D.
Telephone Number	:	352-361-5205

Provider Enumeration Date	:	03/28/2010
Last Update Date	:	03/28/2010

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Directions to “TUCKER EYE-EXAM & CONTACT LENS CENTER ” Practice Location

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