MEDICARE: EYE Q 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	156FX1800X	Optician	DO1058	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457537284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE Q INC

Provider Business Mailing Address
First Line	:	6486 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3008
Country	:	US
Telephone Number	:	561-968-4942
Fax Number	:

Provider Business Practice Location Address
First Line	:	6486 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3008
Country	:	US
Telephone Number	:	561-968-4942
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN SOLE OWNER
Name	:	MR. LAWRENCE MITCHELL WOLMETZ
Credential	:	LDO
Telephone Number	:	561-968-1259

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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Directions to “EYE Q INC ” Practice Location

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