MEDICARE: CLAUDE OPTICAL, 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1245761006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAUDE OPTICAL, LLC

Provider Business Mailing Address
First Line	:	7975 NESBIT FERRY RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-1005
Country	:	US
Telephone Number	:	305-467-6980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 PEACHTREE BLVD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-2719
Country	:	US
Telephone Number	:	305-467-6980
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. TIMOTHY RHYSE PARKER
Credential	:
Telephone Number	:	305-467-6980

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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