MEDICARE: MJC VISION

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	03329TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245413384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJC VISION

Provider Business Mailing Address
First Line	:	7728 MID CITIES BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4621
Country	:	US
Telephone Number	:	817-281-3386
Fax Number	:	817-281-9287

Provider Business Practice Location Address
First Line	:	7728 MID CITIES BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4621
Country	:	US
Telephone Number	:	817-281-3386
Fax Number	:	817-281-9287

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. MARIO JOSEPH CONTALDI
Credential	:	O.D.
Telephone Number	:	817-281-3386

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	10/10/2008

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