MEDICARE: GLACIER OPTICAL

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

General Provider Information

NPI Number	:	1356000301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLACIER OPTICAL

Provider Business Mailing Address
First Line	:	9889 BELLAIRE BLVD STE 252
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3593
Country	:	US
Telephone Number	:	713-774-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	9889 BELLAIRE BLVD STE 252
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3593
Country	:	US
Telephone Number	:	713-774-2773
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DAW-CHING YU
Credential	:	ABOC, NCLC
Telephone Number	:	713-774-2773

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	12/16/2021

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Directions to “GLACIER OPTICAL ” Practice Location

Language	Start Address	Practice Location

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