MEDICARE: MARIETTA EYE OPTICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1831321207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIETTA EYE OPTICAL INC

Provider Business Mailing Address
First Line	:	895 CANTON RD NE
Second Line	:	BLDG 100
City	:	MARIETTA
State	:	GA
Zip	:	30060-8934
Country	:	US
Telephone Number	:	770-427-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 CALIBRE CROSSING, NW.
Second Line	:	SUITE 1104
City	:	ACWORTH
State	:	GA
Zip	:	30101-4108
Country	:	US
Telephone Number	:	678-279-1141
Fax Number	:	678-279-1147

Authorized Official
Title or Position	:	OPTICAL DIRECTOR
Name	:	TIA MCENTIRE
Credential	:
Telephone Number	:	678-784-0242

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	04/03/2018

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Directions to “MARIETTA EYE OPTICAL INC ” Practice Location

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