MEDICARE: EYE 2 EYE MOBILE DOCS

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	5506	OH

General Provider Information

NPI Number	:	1720499718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE 2 EYE MOBILE DOCS

Provider Business Mailing Address
First Line	:	2220 GRANDVIEW DR
Second Line	:	STE 120
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-1695
Country	:	US
Telephone Number	:	858-578-0393
Fax Number	:	859-815-8896

Provider Business Practice Location Address
First Line	:	2220 GRANDVIEW DR
Second Line	:	STE 120
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-1695
Country	:	US
Telephone Number	:	858-578-0393
Fax Number	:	859-815-8896

Authorized Official
Title or Position	:	MEMBER/DOCTOR
Name	:	DR. KENNETH NORMAN SAWYER III
Credential	:	OD
Telephone Number	:	513-633-0060

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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Directions to “EYE 2 EYE MOBILE DOCS ” Practice Location

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