MEDICARE: RESTORED IMAGES 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	335E00000X	Prosthetic/Orthotic Supplier	14757222	MO
2	332B00000X	Durable Medical Equipment & Medical Supplies	14757222	MO

General Provider Information

NPI Number	:	1043315641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORED IMAGES INC

Provider Business Mailing Address
First Line	:	4116 NE VIVION RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2811
Country	:	US
Telephone Number	:	816-454-2900
Fax Number	:	816-454-5881

Provider Business Practice Location Address
First Line	:	4116 NE VIVION RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2811
Country	:	US
Telephone Number	:	816-454-2900
Fax Number	:	816-454-5881

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. REBECCA WILLS
Credential	:
Telephone Number	:	816-454-2900

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	04/12/2012

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Directions to “RESTORED IMAGES INC ” Practice Location

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