Provider Demographics
NPI:1447325568
Name:MARCIANO FAMILY OPTOMETRIC
Entity type:Organization
Organization Name:MARCIANO FAMILY OPTOMETRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MARCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-242-1200
Mailing Address - Street 1:1788 N. JOG RD.
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-0000
Mailing Address - Country:US
Mailing Address - Phone:561-242-1200
Mailing Address - Fax:561-242-1291
Practice Address - Street 1:1788 N. JOG RD.
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-0000
Practice Address - Country:US
Practice Address - Phone:561-242-1200
Practice Address - Fax:561-242-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 003248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5446497OtherCIGNA
FL20844OtherBLUE CROSS & BLUE SHIELD
FL002368580OtherUNITED HEALTHCARE
FLM620930100Medicaid
FLK6239Medicare PIN