MEDICARE: EYE DESIGNS OPTICAL

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	106442	VA

General Provider Information

NPI Number	:	1275735870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE DESIGNS OPTICAL

Provider Business Mailing Address
First Line	:	1227 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4707
Country	:	US
Telephone Number	:	540-342-6664
Fax Number	:	540-342-7063

Provider Business Practice Location Address
First Line	:	1227 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4707
Country	:	US
Telephone Number	:	540-342-6664
Fax Number	:	540-342-7063

Authorized Official
Title or Position	:	MANAGING OPTICIAN
Name	:	MR. STEPHEN E MERRICKS
Credential	:
Telephone Number	:	540-342-6664

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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Directions to “EYE DESIGNS OPTICAL ” Practice Location

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