MEDICARE: DONALD G. PURCELL, O.D., 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	152WC0802X	Corneal and Contact Management Optometrist	OPC003512	FL

General Provider Information

NPI Number	:	1932439395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD G. PURCELL, O.D., P.A.

Provider Business Mailing Address
First Line	:	1700 W INTERNATIONAL SPEEDWAY BLVD
Second Line	:	SUITE # 432
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-1387
Country	:	US
Telephone Number	:	386-255-9585
Fax Number	:	386-255-3404

Provider Business Practice Location Address
First Line	:	1700 W INTERNATIONAL SPEEDWAY BLVD
Second Line	:	SUITE # 432
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-1387
Country	:	US
Telephone Number	:	386-255-9585
Fax Number	:	386-255-3404

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD GLENN PURCELL
Credential	:	O.D.
Telephone Number	:	386-255-9585

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	01/07/2010

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