MEDICARE: CHARLES KREBS OPTICAL SHOPPE

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	332B00000X	Durable Medical Equipment & Medical Supplies	0372	KY

General Provider Information

NPI Number	:	1659552073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES KREBS OPTICAL SHOPPE

Provider Business Mailing Address
First Line	:	129 SAINT MATTHEWS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3141
Country	:	US
Telephone Number	:	502-897-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 SAINT MATTHEWS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3141
Country	:	US
Telephone Number	:	502-897-1199
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MARK BABCOCK
Credential	:
Telephone Number	:	502-897-1199

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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