MEDICARE: INSIGHT EYE CARE, LLC

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

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	:	1720430275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT EYE CARE, LLC

Provider Business Mailing Address
First Line	:	1906 GLENN BLVD SW STE 100-A
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3545
Country	:	US
Telephone Number	:	256-845-5555
Fax Number	:	256-997-9310

Provider Business Practice Location Address
First Line	:	1906 GLENN BLVD SW STE 100-A
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3545
Country	:	US
Telephone Number	:	256-845-5555
Fax Number	:	256-997-9310

Authorized Official
Title or Position	:	MANAGING MEMBERR
Name	:	DR. PETER STROGOV
Credential	:	M.D.
Telephone Number	:	908-294-1014

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	07/21/2022

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Directions to “INSIGHT EYE CARE, LLC ” Practice Location

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