MEDICARE: EAGLE EYE AND MEDICAL CLINIC 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	207W00000X	Ophthalmology Physician	025778	GA

General Provider Information

NPI Number	:	1922254523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE EYE AND MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	3138B HIGHWAY 278 NW
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2304
Country	:	US
Telephone Number	:	770-784-1172
Fax Number	:	770-788-8824

Provider Business Practice Location Address
First Line	:	3138B HIGHWAY 278 NW
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2304
Country	:	US
Telephone Number	:	770-784-1172
Fax Number	:	770-788-8824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NAZIR AHMAD KHAWAJA
Credential	:	M.D
Telephone Number	:	770-784-1172

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/20/2008

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