MEDICARE: ALPHA AND OMEGA VISION CENTER

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	002623	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700244472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA AND OMEGA VISION CENTER

Provider Business Mailing Address
First Line	:	264 GUSTAV CT
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-8212
Country	:	US
Telephone Number	:	803-546-5740
Fax Number	:

Provider Business Practice Location Address
First Line	:	3836 WASHINGTON RD
Second Line	:	SUITE 2
City	:	MARTINEZ
State	:	GA
Zip	:	30907-5058
Country	:	US
Telephone Number	:	706-410-2038
Fax Number	:	706-608-4080

Authorized Official
Title or Position	:	OWNER
Name	:	SHERITA SEWARD-BROWN
Credential	:
Telephone Number	:	803-546-5740

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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Directions to “ALPHA AND OMEGA VISION CENTER ” Practice Location

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