MEDICARE: PINON HILLS 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1922057827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINON HILLS OPTICAL INC

Provider Business Mailing Address
First Line	:	2300 E 30TH ST
Second Line	:	STE 105
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-325-4298
Fax Number	:	505-326-4690

Provider Business Practice Location Address
First Line	:	2300 E 30TH ST
Second Line	:	STE 105
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-325-4298
Fax Number	:	505-326-4690

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAULA VAUGHAN
Credential	:
Telephone Number	:	505-325-5021

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/28/2008

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Directions to “PINON HILLS OPTICAL INC ” Practice Location

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