MEDICARE: EYE CANDY OPTICAL CENTER

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	152WC0802X	Corneal and Contact Management Optometrist	OEG001269	PA

General Provider Information

NPI Number	:	1053541342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CANDY OPTICAL CENTER

Provider Business Mailing Address
First Line	:	4007 WASHINGTON ROAD
Second Line	:	DONALDSON'S CROSSROADS
City	:	MCMURRAY
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-941-5100
Fax Number	:	724-941-5380

Provider Business Practice Location Address
First Line	:	4007 WASHINGTON RD
Second Line	:	DONALDSON'S CROSSROADS
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-941-5100
Fax Number	:	724-941-5380

Authorized Official
Title or Position	:	OPTOMETRIS
Name	:	DR. MONIKA AGNIESZKA MARCZAK
Credential	:	O.D.
Telephone Number	:	724-941-5100

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2009

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