MEDICARE: BEREA 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	156FX1800X	Optician	KY 1075	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KY 1075	OTHER	KY	EYEMED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316162019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEREA OPTICAL LLC

Provider Business Mailing Address
First Line	:	400 RICHMOND RD N
Second Line	:	SUITE F
City	:	BEREA
State	:	KY
Zip	:	40403-1015
Country	:	US
Telephone Number	:	859-985-0044
Fax Number	:	859-985-0045

Provider Business Practice Location Address
First Line	:	400 RICHMOND RD N
Second Line	:	STE. F
City	:	BEREA
State	:	KY
Zip	:	40403-1015
Country	:	US
Telephone Number	:	859-985-0044
Fax Number	:	859-985-0045

Authorized Official
Title or Position	:	OWNER
Name	:	REBA JUNE FRANK
Credential	:
Telephone Number	:	859-985-0044

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “BEREA OPTICAL LLC ” Practice Location

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