MEDICARE: MIDTOWN OPTICAL 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	152W00000X	Optometrist	1371T	GA

General Provider Information

NPI Number	:	1134426356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN OPTICAL INC

Provider Business Mailing Address
First Line	:	650 PONCE DE LEON AVE NE
Second Line	:	SUITE 630A
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	404-897-5767
Fax Number	:	404-897-3839

Provider Business Practice Location Address
First Line	:	650 PONCE DE LEON AVE NE
Second Line	:	SUITE 630A
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	404-897-5767
Fax Number	:	404-897-3839

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ROBERT JOSEPH BARNES
Credential	:	OD
Telephone Number	:	404-897-5767

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	02/24/2011

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