MEDICARE: RHEA OPTICAL 20/20

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

General Provider Information

NPI Number	:	1700498334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHEA OPTICAL 20/20

Provider Business Mailing Address
First Line	:	1901 BROADWAY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4536
Country	:	US
Telephone Number	:	573-335-9149
Fax Number	:	573-335-0655

Provider Business Practice Location Address
First Line	:	1901 BROADWAY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4536
Country	:	US
Telephone Number	:	573-335-9149
Fax Number	:	573-335-0655

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. STEVEN EMMONS
Credential	:
Telephone Number	:	573-335-9149

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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Directions to “RHEA OPTICAL 20/20 ” Practice Location

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