MEDICARE: EYE CARE COMPANY

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1144656190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE COMPANY

Provider Business Mailing Address
First Line	:	2472 S LONG LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1462
Country	:	US
Telephone Number	:	810-714-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2472 S LONG LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1462
Country	:	US
Telephone Number	:	810-714-2020
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	SCOTT MCDOWELL
Credential	:
Telephone Number	:	810-853-2073

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	10/30/2014

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Directions to “EYE CARE COMPANY ” Practice Location

Language	Start Address	Practice Location

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