MEDICARE: GOOD LOOKS EYEWEAR 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	MD037014E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	GL000256582	OTHER	PA	BLUESHIELD

General Provider Information

NPI Number	:	1033100805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LOOKS EYEWEAR INC

Provider Business Mailing Address
First Line	:	105 BRANDT DR
Second Line	:	SUITE 300
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6437
Country	:	US
Telephone Number	:	724-772-5474
Fax Number	:	724-772-5423

Provider Business Practice Location Address
First Line	:	20215 ROUTE 19
Second Line	:	SUITE 104
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6146
Country	:	US
Telephone Number	:	724-772-9090
Fax Number	:	724-772-9160

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	WILLIAM CLARK CHRISTIE
Credential	:	MD
Telephone Number	:	724-772-5420

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/03/2013

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Directions to “GOOD LOOKS EYEWEAR INC ” Practice Location

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