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NPI Code Detail

MEDICARE: MYEYEDR OPTOMETRY OF GEORGIA, LLC

MEDICARE: MYEYEDR OPTOMETRY OF GEORGIA, 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1104210244
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYEYEDR OPTOMETRY OF GEORGIA, LLC
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 15196 US HIGHWAY 19 S
Second Line :
City : THOMASVILLE
State : GA
Zip : 31757-4820
Country : US
Telephone Number : 229-228-4770
Fax Number : 229-225-9060
Authorized Official
Title or Position : SECRETARY
Name : SUE HEALEY
Credential :
Telephone Number : 703-847-8899
Provider Enumeration Date : 03/26/2015
Last Update Date : 05/26/2022

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