MEDICARE: LUM'S OPTICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies	076103019	MS

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	:	1760534309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUM'S OPTICAL INC

Provider Business Mailing Address
First Line	:	1550 N MEDICAL PARK DR STE B
Second Line	:	SUITE B
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7239
Country	:	US
Telephone Number	:	662-335-4553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 N MEDICAL PARK DR STE B
Second Line	:	SUITE B
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7239
Country	:	US
Telephone Number	:	662-335-4553
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLIE L LUM
Credential	:	OPTICIAN
Telephone Number	:	662-335-4553

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	09/16/2008

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Directions to “LUM'S OPTICAL INC ” Practice Location

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