MEDICARE: 4QUARTERS OPTICAL, LLC

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	3207	NJ

General Provider Information

NPI Number	:	1871788992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4QUARTERS OPTICAL, LLC

Provider Business Mailing Address
First Line	:	644 BUENAVENTURA CT
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3487
Country	:	US
Telephone Number	:	732-775-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 3RD AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6417
Country	:	US
Telephone Number	:	732-775-6969
Fax Number	:	732-775-6666

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LAURIE SCHOENBERGER
Credential	:
Telephone Number	:	732-775-6969

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	10/23/2008

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