MEDICARE: EMERGING VISION 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	:	1003210675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGING VISION INC.

Provider Business Mailing Address
First Line	:	520 8TH AVE
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10018-6507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 HERITAGE DR
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2127
Country	:	US
Telephone Number	:	262-646-9600
Fax Number	:	262-646-9603

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	FRANCINE M SUAREZ
Credential	:
Telephone Number	:	212-729-5331

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

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Directions to “EMERGING VISION INC. ” Practice Location

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