MEDICARE: FIVE POINTS OPTOMETRISTS, PC

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		GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GRP3442	OTHER	GA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568657880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE POINTS OPTOMETRISTS, PC

Provider Business Mailing Address
First Line	:	698 S MILLEDGE AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-1251
Country	:	US
Telephone Number	:	706-543-2020
Fax Number	:	706-549-6618

Provider Business Practice Location Address
First Line	:	698 S MILLEDGE AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-1251
Country	:	US
Telephone Number	:	706-543-2020
Fax Number	:	706-549-6618

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. ROSE MARIE ISREAL
Credential	:
Telephone Number	:	706-543-2020

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	03/07/2013

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