MEDICARE: GODSEY ENTERPRISES 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	156FX1800X	Optician	DPO174	TN

General Provider Information

NPI Number	:	1033383310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GODSEY ENTERPRISES INC

Provider Business Mailing Address
First Line	:	111 BROYLES ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2532
Country	:	US
Telephone Number	:	423-282-1932
Fax Number	:	423-282-8813

Provider Business Practice Location Address
First Line	:	111 BROYLES ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2532
Country	:	US
Telephone Number	:	423-282-1932
Fax Number	:	423-282-8813

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY GODSEY
Credential	:
Telephone Number	:	423-282-1932

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	05/06/2008

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Directions to “GODSEY ENTERPRISES INC ” Practice Location

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