MEDICARE: WINCHESTER 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	332B00000X	Durable Medical Equipment & Medical Supplies	TN OD 494	TN

General Provider Information

NPI Number	:	1730209024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINCHESTER OPTICAL

Provider Business Mailing Address
First Line	:	183 HOSPITAL RD
Second Line	:
City	:	WINCHESTER
State	:	TN
Zip	:	37398-2470
Country	:	US
Telephone Number	:	931-967-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 HOSPITAL RD
Second Line	:
City	:	WINCHESTER
State	:	TN
Zip	:	37398-2470
Country	:	US
Telephone Number	:	931-967-2230
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN
Name	:	LANA BRADLEY
Credential	:
Telephone Number	:	931-967-2230

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	01/30/2008

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Directions to “WINCHESTER OPTICAL ” Practice Location

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