MEDICARE: OPTICAL SUPPLY

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		AL

General Provider Information

NPI Number	:	1568732212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL SUPPLY

Provider Business Mailing Address
First Line	:	132 JESTER PKWY
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6737
Country	:	US
Telephone Number	:	256-442-2000
Fax Number	:	256-442-4775

Provider Business Practice Location Address
First Line	:	132 JESTER PKWY
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6737
Country	:	US
Telephone Number	:	125-644-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MICHAEL TODD EUBANKS
Credential	:
Telephone Number	:	256-442-2000

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “OPTICAL SUPPLY ” Practice Location

Language	Start Address	Practice Location

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