MEDICARE: TRAVIS OPTICAL

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	156FX1800X	Optician	341	NC

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	:	1982760922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVIS OPTICAL

Provider Business Mailing Address
First Line	:	PO BOX 15118
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-0118
Country	:	US
Telephone Number	:	919-477-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 N ROXBORO RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-0118
Country	:	US
Telephone Number	:	919-477-4006
Fax Number	:	919-477-4006

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRED MATTHEW TRAVIS
Credential	:	OPTICIAN
Telephone Number	:	919-477-4006

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2020

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Directions to “TRAVIS OPTICAL ” Practice Location

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