MEDICARE: OLNEY EYECARE

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	332B00000X	Durable Medical Equipment & Medical Supplies	046-008793	IL

General Provider Information

NPI Number	:	1134376759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLNEY EYECARE

Provider Business Mailing Address
First Line	:	429 S WHITTLE AVE
Second Line	:
City	:	OLNEY
State	:	IL
Zip	:	62450-2262
Country	:	US
Telephone Number	:	618-395-2676
Fax Number	:	618-395-2720

Provider Business Practice Location Address
First Line	:	429 S WHITTLE AVE
Second Line	:
City	:	OLNEY
State	:	IL
Zip	:	62450-2262
Country	:	US
Telephone Number	:	618-395-2676
Fax Number	:	618-395-2720

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. JOHN R WILLIAMS
Credential	:
Telephone Number	:	618-395-2676

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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Directions to “OLNEY EYECARE ” Practice Location

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