MEDICARE: TILL EYECARE 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	18004036A	IN

General Provider Information

NPI Number	:	1982125134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TILL EYECARE LLC

Provider Business Mailing Address
First Line	:	5535 S SCATTERFIELD RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46013-3140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 S SCATTERFIELD RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46013-3140
Country	:	US
Telephone Number	:	260-385-9178
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN TILL
Credential	:	OD
Telephone Number	:	260-385-9178

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	08/01/2017

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Directions to “TILL EYECARE LLC ” Practice Location

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