MEDICARE: FOR EYES OPTICAL OF PA

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

General Provider Information

NPI Number	:	1770057762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOR EYES OPTICAL OF PA

Provider Business Mailing Address
First Line	:	3601 SW 160TH AVE STE 400
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-6312
Country	:	US
Telephone Number	:	305-557-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 W TOWNLINE RD STE 120
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4333
Country	:	US
Telephone Number	:	847-918-0424
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KIM GRIFFIN
Credential	:
Telephone Number	:	305-557-9004

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/14/2019

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