MEDICARE: PRESLEY VISION SERVICES, 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	18003067	IN

General Provider Information

NPI Number	:	1659524502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESLEY VISION SERVICES, PC

Provider Business Mailing Address
First Line	:	11433 BROMLEY CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-2044
Country	:	US
Telephone Number	:	260-403-4909
Fax Number	:

Provider Business Practice Location Address
First Line	:	10240 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2035
Country	:	US
Telephone Number	:	260-497-8626
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHELE WHITE PRESLEY
Credential	:	OD
Telephone Number	:	260-497-8626

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	10/23/2008

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