MEDICARE: FELTZ MOBILE OPTOMETRY 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	2045	KS

General Provider Information

NPI Number	:	1316499460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FELTZ MOBILE OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	12910 SHELBYVILLE RD
Second Line	:	SUITE 300
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1593
Country	:	US
Telephone Number	:	855-259-9183
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 N CHESTNUT ST
Second Line	:
City	:	LINDSBORG
State	:	KS
Zip	:	67456-1904
Country	:	US
Telephone Number	:	785-227-2334
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW FELTZ
Credential	:	OD
Telephone Number	:	855-259-9183

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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