MEDICARE: MARIETTA OPHTHALMOLOGY ASSOCIATES 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
1	207W00000X	Ophthalmology Physician	55641	OH

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	:	1639171010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIETTA OPHTHALMOLOGY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	210 N 7TH ST
Second Line	:	SUITE 200
City	:	MARIETTA
State	:	OH
Zip	:	45750-2244
Country	:	US
Telephone Number	:	740-373-8046
Fax Number	:	740-373-0182

Provider Business Practice Location Address
First Line	:	210 N SEVENTH ST
Second Line	:	SUITE 200
City	:	MARIETTA
State	:	OH
Zip	:	45750-2244
Country	:	US
Telephone Number	:	740-373-8046
Fax Number	:	740-373-0182

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRENDA FAYE JONES
Credential	:	MD
Telephone Number	:	740-373-8046

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/03/2011

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