MEDICARE: OPTOM-EYES, 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	152W00000X	Optometrist	2178	CO

General Provider Information

NPI Number	:	1730215500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOM-EYES, INC.

Provider Business Mailing Address
First Line	:	3585 VAN TEYLINGEN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4875
Country	:	US
Telephone Number	:	719-550-3937
Fax Number	:	719-268-6694

Provider Business Practice Location Address
First Line	:	3585 VAN TEYLINGEN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4875
Country	:	US
Telephone Number	:	719-550-3937
Fax Number	:	719-268-6694

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN MICHAEL RABINS
Credential	:	O.D.
Telephone Number	:	719-550-3937

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	05/04/2011

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Directions to “OPTOM-EYES, INC. ” Practice Location

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