MEDICARE: MONIQUE BATCHELOR, 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	152W00000X	Optometrist	OPT002626	GA

General Provider Information

NPI Number	:	1255695284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONIQUE BATCHELOR, LLC

Provider Business Mailing Address
First Line	:	4735 JONESBORO RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-1915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4735 JONESBORO RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-1915
Country	:	US
Telephone Number	:	770-969-5976
Fax Number	:	770-969-6140

Authorized Official
Title or Position	:	DR.
Name	:	MONIQUE N BATCHELOR
Credential	:	OD
Telephone Number	:	770-969-5976

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	10/16/2013

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