MEDICARE: EYE DOC 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	453	NV

General Provider Information

NPI Number	:	1437484896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE DOC INC.

Provider Business Mailing Address
First Line	:	8512 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1818
Country	:	US
Telephone Number	:	702-450-3937
Fax Number	:	702-933-9094

Provider Business Practice Location Address
First Line	:	8512 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1818
Country	:	US
Telephone Number	:	702-450-3937
Fax Number	:	702-933-9094

Authorized Official
Title or Position	:	OWNER
Name	:	MISS KELLI ANNE MCLAUGHLIN
Credential	:	O.D.
Telephone Number	:	702-450-3937

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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