MEDICARE: ATHENS VISION CENTERS, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1033811104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENS VISION CENTERS, LLC

Provider Business Mailing Address
First Line	:	105 TRINITY PL
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30607-2112
Country	:	US
Telephone Number	:	706-549-9993
Fax Number	:	706-549-4047

Provider Business Practice Location Address
First Line	:	17 S THOMAS ST
Second Line	:
City	:	ELBERTON
State	:	GA
Zip	:	30635-2453
Country	:	US
Telephone Number	:	706-549-9993
Fax Number	:	706-549-4047

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOHN HENRY BO DALTON
Credential	:
Telephone Number	:	706-433-2031

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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