MEDICARE: FOR EYES 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

General Provider Information

NPI Number	:	1760723993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOR EYES OPTICAL

Provider Business Mailing Address
First Line	:	PO BOX 102472
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-2472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 VIRGINIA BEACH BLVD
Second Line	:	LYNNHAVEN CONVENIENCE CENTER
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7615
Country	:	US
Telephone Number	:	757-995-0092
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PHILIP WOLMAN
Credential	:
Telephone Number	:	305-557-9004

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	10/01/2013

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