MEDICARE: OCCHIALI

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	332H00000X	Eyewear Supplier	3933	CA

General Provider Information

NPI Number	:	1194911925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCHIALI

Provider Business Mailing Address
First Line	:	1046 COAST VILLAGE RD
Second Line	:
City	:	MONTECITO
State	:	CA
Zip	:	93108-2732
Country	:	US
Telephone Number	:	805-565-3415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1046 COAST VILLAGE RD
Second Line	:
City	:	MONTECITO
State	:	CA
Zip	:	93108-2732
Country	:	US
Telephone Number	:	805-565-3415
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SALLI ELEAN EVE
Credential	:
Telephone Number	:	805-565-3415

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	06/30/2008

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