MEDICARE: ESSILOR LABORATORIES OF AMERICA, 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	:	1962692186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSILOR LABORATORIES OF AMERICA, INC

Provider Business Mailing Address
First Line	:	13515 N STEMMONS FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-5765
Country	:	US
Telephone Number	:	800-843-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3844 E 5TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-5145
Country	:	US
Telephone Number	:	800-303-5885
Fax Number	:

Authorized Official
Title or Position	:	SR. VICE PRESIDENT
Name	:	REAL GOULET
Credential	:
Telephone Number	:	214-496-4105

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	08/03/2007

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