MEDICARE: PROFESSIONAL EYE ASSOCIATES, 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1770678948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL EYE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	1111 PROFESSIONAL BLVD
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2588
Country	:	US
Telephone Number	:	706-226-2020
Fax Number	:	706-217-2876

Provider Business Practice Location Address
First Line	:	136 W BELMONT DR
Second Line	:	SUITE 3
City	:	CALHOUN
State	:	GA
Zip	:	30701-3064
Country	:	US
Telephone Number	:	706-602-7775
Fax Number	:	706-602-2078

Authorized Official
Title or Position	:	COO
Name	:	MRS. SANDRA D CURD
Credential	:
Telephone Number	:	706-226-2020

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/09/2019

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