MEDICARE: THE OPTICAL PLACE, 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		NC

General Provider Information

NPI Number	:	1972609071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OPTICAL PLACE, INC.

Provider Business Mailing Address
First Line	:	2633 RANDLEMAN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-5107
Country	:	US
Telephone Number	:	336-274-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 RANDLEMAN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-5107
Country	:	US
Telephone Number	:	336-274-1300
Fax Number	:	336-370-1273

Authorized Official
Title or Position	:	OPTICIAN/STORE MANAGER
Name	:	MRS. TERESA H CARTER
Credential	:
Telephone Number	:	336-274-1300

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	04/20/2012

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Directions to “THE OPTICAL PLACE, INC. ” Practice Location

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