MEDICARE: LEISURE WORLD OPTICIANS 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	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1750369120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEISURE WORLD OPTICIANS INC

Provider Business Mailing Address
First Line	:	3804 INTERNATIONAL DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-1548
Country	:	US
Telephone Number	:	301-598-4614
Fax Number	:	301-598-4615

Provider Business Practice Location Address
First Line	:	3804 INTERNATIONAL DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-1548
Country	:	US
Telephone Number	:	301-598-4614
Fax Number	:	301-598-4615

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GLENN W MANN
Credential	:	LICENCED OPTICIAN
Telephone Number	:	301-598-4614

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	02/29/2008

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Directions to “LEISURE WORLD OPTICIANS INC ” Practice Location

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