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Organization

MYTHIC EYEWEAR LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRAVIS SCONYERS LDO (OWNER)
(478) 973-2227
Entity
Organization

Contact information

Practice address
1025 AHWENASA TRL, MACON, GA 31220-3606
(478) 973-2227
Mailing address
4658 PRESIDENTIAL PKWY # 1058, MACON, GA 31206-8708
(478) 973-2227

Taxonomy

Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
156FC0800X
Contact Lens Technician/Technologist
156FC0801X
Contact Lens Fitter
156FX1100X
Ophthalmic Technician/Technologist
156FX1101X
Ophthalmic Assistant
156FX1201X
Optometric Assistant Technician
156FX1202X
Optometric Technician
156FX1800X
Optician
Primary
332H00000X
Eyewear Supplier

Other

Enumeration date
03/06/2024
Last updated
03/06/2024
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