MEDICARE: CLEVELAND 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
1	156FX1800X	Optician		MS

General Provider Information

NPI Number	:	1689852519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND OPTICAL INC

Provider Business Mailing Address
First Line	:	PO BOX 1170
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-1170
Country	:	US
Telephone Number	:	662-843-5328
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 1ST ST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2310
Country	:	US
Telephone Number	:	662-843-5328
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES H BOGGS
Credential	:	OPTICIAN
Telephone Number	:	662-843-5328

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	03/14/2008

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Directions to “CLEVELAND OPTICAL INC ” Practice Location

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