MEDICARE: POSHOPTIQUE,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	S.9857	OH

General Provider Information

NPI Number	:	1891068235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSHOPTIQUE,LLC

Provider Business Mailing Address
First Line	:	600 SUPERIOR AVE E
Second Line	:	SUITE 1300
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	216-338-7701
Fax Number	:	216-479-6801

Provider Business Practice Location Address
First Line	:	600 SUPERIOR AVE E
Second Line	:	SUITE 1300
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	216-338-7701
Fax Number	:	216-479-6801

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHAFEEQA HUSSEIN-BEY
Credential	:	ABOC,LDO
Telephone Number	:	216-338-7701

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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