MEDICARE: MODERNEYES VISION CARE, LLC

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	:	1891433132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERNEYES VISION CARE, LLC

Provider Business Mailing Address
First Line	:	58 E DOYLE ST
Second Line	:
City	:	TOCCOA
State	:	GA
Zip	:	30577-3009
Country	:	US
Telephone Number	:	706-599-5407
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 E DOYLE ST
Second Line	:
City	:	TOCCOA
State	:	GA
Zip	:	30577-3009
Country	:	US
Telephone Number	:	706-599-5407
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LINDSAY MARTIN
Credential	:	OD
Telephone Number	:	706-599-5407

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	06/03/2022

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