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1573 South Wickham Road, West Melbourne, FL 32904-3540 | |
| (321) 723-8115 | |
| (321) 723-7388 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 1573 South Wickham Road, West Melbourne, Florida |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104911098 | NPI | - | NPPES |
| K6081 | Other | FL | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | FL2531 (Florida) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
1573 South Wickham Road, West Melbourne, FL 32904-3540 Ph: (321) 723-8115 | 1573 South Wickham Road, West Melbourne, FL 32904-3540 Ph: (321) 723-8115 |
Diana Catalina Hernandez, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 964 S Wickham Rd Ste 1, West Melbourne, FL 32904 Phone: 321-339-2211 Fax: 321-339-1183 | |
Dr. Cortez Ramon Lewis, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1573 S Wickham Rd, West Melbourne, FL 32904 Phone: 321-220-0394 Fax: 239-232-8881 | |
Dr. Andreanos Jordanopoulos, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1573 South Wickham Road, West Melbourne, FL 32904 Phone: 321-723-8115 Fax: 321-723-7388 | |
William D. Tanke, Od, Pa Optometrist Medicare: Medicare Enrolled Practice Location: 1813 W New Haven Ave, West Melbourne, FL 32904 Phone: 321-951-2020 | |
Samuel Winn, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1813 W New Haven Ave, West Melbourne, FL 32904 Phone: 321-951-2220 Fax: 321-722-4754 |