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NPI Code Detail

MEDICARE: WARNER ROBINS OPTICAL, INC.

MEDICARE: WARNER ROBINS OPTICAL, INC.
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
1332H00000XEyewear SupplierLDO000695GA

General Provider Information

NPI Number : 1629268883
Entity Type Code : Organization
Provider Name (Legal Business Name) : WARNER ROBINS OPTICAL, INC.
Provider Business Mailing Address
First Line : 212A CORDER RD
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-3604
Country : US
Telephone Number : 478-929-2020
Fax Number :
Provider Business Practice Location Address
First Line : 212A CORDER RD
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-3604
Country : US
Telephone Number : 478-929-2020
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. ADDISON BAILEY MCREE
Credential : LDO
Telephone Number : 478-746-4866
Provider Enumeration Date : 07/25/2007
Last Update Date : 07/25/2007

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