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Richard D. Spolzino

Optometrist

Eye and Vision Services Providers

1550 Riverstone Pkwy, Canton, GA 30114-2889

PECOS Enrollment

This provider is enrolled in PECOS as RICHARD SPOLZINO.

Based on the most recent information from CMS, provider Richard D. Spolzino is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 11 days ago.

Profile Details

Provider ID
1760521348
Provider Type
Individual
Full Name
Spolzino, Richard D.
Title
Dr.
Credential
O.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
2/6/2007
Last Updated
7/8/2007

Contact Information

Practice Location

1550 Riverstone Pkwy, Canton, GA 30114-2889

(770) 720-1025

Unlisted Fax

Mailing Location

15780 Manor Trace, Alpharetta, GA 30004

(770) 754-9140

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License OPT002303 Georgia

Provider Identifiers

ID	Description	Issuer
ID 43854	Description Other	Issuer SPECTERA VISION PLAN Georgia
ID 114964	Description Other	Issuer EYEMED VISION PLAN Georgia

Richard D. Spolzino

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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