MEDICARE: EYEAR 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	332B00000X	Durable Medical Equipment & Medical Supplies	1187	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205843885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEAR OPTICAL, INC

Provider Business Mailing Address
First Line	:	1281 BATTLEFIELD PKWY
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-4009
Country	:	US
Telephone Number	:	706-861-7053
Fax Number	:	706-861-7810

Provider Business Practice Location Address
First Line	:	1281 BATTLEFIELD PKWY
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-4009
Country	:	US
Telephone Number	:	706-861-7053
Fax Number	:	706-861-7810

Authorized Official
Title or Position	:	OWNER
Name	:	CINDY C HENDERSON
Credential	:	OPTICIAN
Telephone Number	:	706-861-7053

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2008

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Directions to “EYEAR OPTICAL, INC ” Practice Location

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