MEDICARE: WIMMER OPTICAL

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	332H00000X	Eyewear Supplier	8410	VA

General Provider Information

NPI Number	:	1710429592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIMMER OPTICAL

Provider Business Mailing Address
First Line	:	730 E CHURCH ST STE 22
Second Line	:	P.O BOX 4629
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-3151
Country	:	US
Telephone Number	:	276-403-4678
Fax Number	:	276-403-4679

Provider Business Practice Location Address
First Line	:	730 E CHURCH ST STE 22
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-3151
Country	:	US
Telephone Number	:	276-403-4678
Fax Number	:	276-403-4679

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	MR. MICHAEL WIMMER
Credential	:	LDO
Telephone Number	:	276-403-4678

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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Directions to “WIMMER OPTICAL ” Practice Location

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