MEDICARE: THE EYEGLASS PLACE

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	1101001399	VA

General Provider Information

NPI Number	:	1760658702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EYEGLASS PLACE

Provider Business Mailing Address
First Line	:	PO BOX 904
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-0904
Country	:	US
Telephone Number	:	276-236-4066
Fax Number	:	276-236-4066

Provider Business Practice Location Address
First Line	:	544 E STUART DR
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-2231
Country	:	US
Telephone Number	:	276-236-4066
Fax Number	:	276-236-4066

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	MARY MARGARET RECTOR
Credential	:	R.O.
Telephone Number	:	276-236-4066

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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Directions to “THE EYEGLASS PLACE ” Practice Location

Language	Start Address	Practice Location

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