MEDICARE: ADVANCED OPTOMETRY

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	:	1528621521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED OPTOMETRY

Provider Business Mailing Address
First Line	:	131 GLENSFORD DR STE 105
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2365
Country	:	US
Telephone Number	:	910-860-2020
Fax Number	:	910-864-3719

Provider Business Practice Location Address
First Line	:	131 GLENSFORD DR STE 105
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2365
Country	:	US
Telephone Number	:	910-860-2020
Fax Number	:	910-864-3719

Authorized Official
Title or Position	:	OPTOMETRIST/DOCTOR
Name	:	DR. KERRY M REEVES
Credential	:	OD
Telephone Number	:	910-860-2020

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	04/16/2019

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Directions to “ADVANCED OPTOMETRY ” Practice Location

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