MEDICARE: NORTH COLUMBUS EYE CENTER, PC

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	207W00000X	Ophthalmology Physician		GA

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	:	1831251826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COLUMBUS EYE CENTER, PC

Provider Business Mailing Address
First Line	:	1240 BROOKSTONE CENTRE PARKWAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2988
Country	:	US
Telephone Number	:	706-323-8127
Fax Number	:	706-596-4839

Provider Business Practice Location Address
First Line	:	1240 BROOKSTONE CENTRE PARKWAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2988
Country	:	US
Telephone Number	:	706-323-8127
Fax Number	:	706-596-4849

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH F CERAVOLO
Credential	:	MD
Telephone Number	:	706-323-8127

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	11/16/2010

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