MEDICARE: IN FOCUS EYE CENTER, P.C.

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	OPT002316	GA

General Provider Information

NPI Number	:	1578703872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN FOCUS EYE CENTER, P.C.

Provider Business Mailing Address
First Line	:	995 GILBERT ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2567
Country	:	US
Telephone Number	:	404-660-5149
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 N HIGHLAND AVE NE
Second Line	:	SUITE B
City	:	ATLANTA
State	:	GA
Zip	:	30307-5609
Country	:	US
Telephone Number	:	404-589-0822
Fax Number	:	404-589-4766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAY E CHRETIEN
Credential	:	O.D.
Telephone Number	:	404-660-5149

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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