MEDICARE: MYERS OPTICAL CENTER INC.

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	156FX1800X	Optician	765	NC

General Provider Information

NPI Number	:	1053338012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYERS OPTICAL CENTER INC.

Provider Business Mailing Address
First Line	:	1509 CHARLOTTE HWY
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-8759
Country	:	US
Telephone Number	:	828-628-6700
Fax Number	:	828-628-6702

Provider Business Practice Location Address
First Line	:	1509 CHARLOTTE HWY
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-8759
Country	:	US
Telephone Number	:	828-628-6700
Fax Number	:	828-628-6702

Authorized Official
Title or Position	:	OPTICIAN/PRESIDENT
Name	:	MATOKA L BLACK
Credential	:
Telephone Number	:	828-628-6700

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2020

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