MEDICARE: CONTACT LENS SPECIALIST

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	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45233	OTHER	VA	SPECTERA

General Provider Information

NPI Number	:	1508021072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTACT LENS SPECIALIST

Provider Business Mailing Address
First Line	:	1336 GASKINS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4919
Country	:	US
Telephone Number	:	804-741-4218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 GASKINS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-4919
Country	:	US
Telephone Number	:	804-741-4218
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS PATRICIA GUIN EDWARDS
Credential	:	OPTICIAN
Telephone Number	:	804-741-4218

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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Directions to “CONTACT LENS SPECIALIST ” Practice Location

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