MEDICARE: EYE Q 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	152W00000X	Optometrist		FL
2	332H00000X	Eyewear Supplier		FL

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	:	1255504858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE Q INC

Provider Business Mailing Address
First Line	:	10156 LEXINGTON ESTATES BLVD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4256
Country	:	US
Telephone Number	:	561-477-9955
Fax Number	:	561-470-3601

Provider Business Practice Location Address
First Line	:	6486 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3008
Country	:	US
Telephone Number	:	561-968-4942
Fax Number	:	561-721-0714

Authorized Official
Title or Position	:	OWNER / MANAGER
Name	:	LAWRENCE MITCHELL WOLMETZ
Credential	:
Telephone Number	:	561-477-9955

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	11/06/2017

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Directions to “EYE Q INC ” Practice Location

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