MEDICARE: EYEWORKS OF ATLANTA, 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	LDO002182	GA

General Provider Information

NPI Number	:	1538466891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEWORKS OF ATLANTA, LLC

Provider Business Mailing Address
First Line	:	800 PEACHTREE STREET
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308
Country	:	US
Telephone Number	:	404-377-3937
Fax Number	:	404-377-3936

Provider Business Practice Location Address
First Line	:	800 PEACHTREE ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-1245
Country	:	US
Telephone Number	:	404-377-3937
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. LUIS ROMAN
Credential	:	LDO
Telephone Number	:	404-377-3937

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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