MEDICARE: ELITE EYE CARE OF HUNTSVILLE

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	S-972TA-544	AL

General Provider Information

NPI Number	:	1689740995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE EYE CARE OF HUNTSVILLE

Provider Business Mailing Address
First Line	:	5161C MOORES MILL RD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-1007
Country	:	US
Telephone Number	:	256-852-6560
Fax Number	:	256-852-6501

Provider Business Practice Location Address
First Line	:	5161C MOORES MILL RD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-1007
Country	:	US
Telephone Number	:	256-852-6560
Fax Number	:	256-852-6501

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MRS. JANE WRIGHT
Credential	:	O.D.
Telephone Number	:	256-852-6560

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/01/2010

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Directions to “ELITE EYE CARE OF HUNTSVILLE ” Practice Location

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