MEDICARE: NEW COLUMBIAN OPTICAL COMPANY

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
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1932423175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW COLUMBIAN OPTICAL COMPANY

Provider Business Mailing Address
First Line	:	325 N 72ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3605
Country	:	US
Telephone Number	:	402-551-9541
Fax Number	:	402-551-9606

Provider Business Practice Location Address
First Line	:	4951 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1407
Country	:	US
Telephone Number	:	817-292-2518
Fax Number	:	817-292-2523

Authorized Official
Title or Position	:	COO
Name	:	MR. ALAN SANDMAN
Credential	:	RETAIL DIRECTOR
Telephone Number	:	516-944-7161

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/17/2010

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Directions to “NEW COLUMBIAN OPTICAL COMPANY ” Practice Location

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