MEDICARE: ABBA EYE CARE PC

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	152W00000X	Optometrist

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	:	1174737605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBA EYE CARE PC

Provider Business Mailing Address
First Line	:	1200 E CAMPBELL RD STE 108
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-1963
Country	:	US
Telephone Number	:	314-741-8183
Fax Number	:	314-741-4947

Provider Business Practice Location Address
First Line	:	4430 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4310
Country	:	US
Telephone Number	:	719-635-2020
Fax Number	:	719-528-1690

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCUS MEYER
Credential	:
Telephone Number	:	719-219-3819

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	01/11/2021

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