MEDICARE: DR. KAY ROYAL OD

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	OPT001460	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619931573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAY ROYAL OD

Provider Business Mailing Address
First Line	:	58 E DOYLE ST
Second Line	:
City	:	TOCCOA
State	:	GA
Zip	:	30577-3009
Country	:	US
Telephone Number	:	706-886-5214
Fax Number	:	706-282-1451

Provider Business Practice Location Address
First Line	:	58 E DOYLE ST
Second Line	:
City	:	TOCCOA
State	:	GA
Zip	:	30577-3009
Country	:	US
Telephone Number	:	706-886-5214
Fax Number	:	706-282-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	02/05/2009

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Directions to “ DR. KAY ROYAL OD” Practice Location

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