| |
2626 Se Willoughby Blvd, Stuart, FL 34994-4700 | |
(772) 286-4878 | |
(772) 286-4368 |
Full Name | |
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Type | Facility |
Speciality | Technician/technologist - Optician |
Location | 2626 Se Willoughby Blvd, Stuart, Florida |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1205955663 | NPI | - | NPPES |
49671 | Other | FL | DAVIS VISION |
20272 | Other | FL | 20272 |
168 | Other | FL | METCARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPC 2404 (Florida) | Primary |
156FX1800X | Technician/technologist - Optician | DO 2488 (Florida) | Primary |
Provider Name | Brad J Waronicki |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1104013069 PECOS PAC ID: 2961467071 Enrollment ID: I20041130000629 |
Mailing Address | Practice Location Address |
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2626 Se Willoughby Blvd, Stuart, FL 34994-4700 Ph: (772) 286-4878 | 2626 Se Willoughby Blvd, Stuart, FL 34994-4700 Ph: (772) 286-4878 |