MEDICARE: TAYLOR-MADE EYEWEAR

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		SC

General Provider Information

NPI Number	:	1689861957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR-MADE EYEWEAR

Provider Business Mailing Address
First Line	:	435 N MAIN ST
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2305
Country	:	US
Telephone Number	:	864-458-7884
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 N MAIN ST
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2305
Country	:	US
Telephone Number	:	864-458-7884
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	TERESA COTHRAN
Credential	:
Telephone Number	:	864-458-7884

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/01/2007

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Directions to “TAYLOR-MADE EYEWEAR ” Practice Location

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