MEDICARE: ALAMANCE EYE PROSTHETICS, 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	335E00000X	Prosthetic/Orthotic Supplier
2	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	023UX	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1477853414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMANCE EYE PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	1736 MAPLE AVE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-6846
Country	:	US
Telephone Number	:	336-228-1403
Fax Number	:	336-228-1503

Provider Business Practice Location Address
First Line	:	1736 MAPLE AVE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-6846
Country	:	US
Telephone Number	:	336-228-1403
Fax Number	:	336-228-1503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL WILLIAM BOYD
Credential	:	OCULARIST
Telephone Number	:	336-228-1403

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	07/17/2013

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