MEDICARE: SECOND SIGHT 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

General Provider Information

NPI Number	:	1467032771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND SIGHT LLC

Provider Business Mailing Address
First Line	:	106 OAKDALE AVE
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3626
Country	:	US
Telephone Number	:	770-833-3589
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W OAK ST
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4233
Country	:	US
Telephone Number	:	770-227-2924
Fax Number	:	770-227-2937

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROSS WILLIAM MONTGOMERY
Credential	:	OD
Telephone Number	:	770-833-3589

Provider Enumeration Date	:	04/11/2021
Last Update Date	:	04/11/2021

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Directions to “SECOND SIGHT LLC ” Practice Location

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