MEDICARE: DISTINCTIVE EYE CARE PC

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	OPT002111	GA

General Provider Information

NPI Number	:	1972836013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTINCTIVE EYE CARE PC

Provider Business Mailing Address
First Line	:	6750 JAMESTOWN DRIVE
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	678-691-0073
Fax Number	:	888-707-4495

Provider Business Practice Location Address
First Line	:	6750 JAMESTOWN DRIVE
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	678-691-0073
Fax Number	:	888-707-4495

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. JENNIFER MARSHALL JAIKARAN
Credential	:	O.D.
Telephone Number	:	678-691-0073

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	06/23/2010

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