MEDICARE: EYEVOLUTION, INC.

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1811141518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEVOLUTION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 722
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-0722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 S FRANKLIN ST
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-3732
Country	:	US
Telephone Number	:	845-353-4701
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW JUDE WATSON
Credential	:	O.D.
Telephone Number	:	845-353-4701

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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Directions to “EYEVOLUTION, INC. ” Practice Location

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