MEDICARE: MHAC OPTICAL

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1053506550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MHAC OPTICAL

Provider Business Mailing Address
First Line	:	6500 W IRVING PARK RD
Second Line	:	SUITE I
City	:	CHICAGO
State	:	IL
Zip	:	60634-2454
Country	:	US
Telephone Number	:	773-202-0181
Fax Number	:	773-202-0189

Provider Business Practice Location Address
First Line	:	6500 W IRVING PARK RD
Second Line	:	SUITE I
City	:	CHICAGO
State	:	IL
Zip	:	60634-2454
Country	:	US
Telephone Number	:	773-202-0181
Fax Number	:	773-202-0189

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIET LEWIS
Credential	:	O.D.
Telephone Number	:	773-202-0181

Provider Enumeration Date	:	09/09/2007
Last Update Date	:	09/09/2007

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Directions to “MHAC OPTICAL ” Practice Location

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