MEDICARE: EASTERN EYE ASSOCIATES, INC. OPTOMETRISTS

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

General Provider Information

NPI Number	:	1790852986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN EYE ASSOCIATES, INC. OPTOMETRISTS

Provider Business Mailing Address
First Line	:	3449 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	HAYES
State	:	VA
Zip	:	23072-3100
Country	:	US
Telephone Number	:	804-642-2290
Fax Number	:	804-684-2166

Provider Business Practice Location Address
First Line	:	3449 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	HAYES
State	:	VA
Zip	:	23072-3100
Country	:	US
Telephone Number	:	804-642-2290
Fax Number	:	804-684-2166

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. MARK K MEADOWS
Credential	:	OD
Telephone Number	:	804-642-2290

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	03/08/2017

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