MEDICARE: MORRELL OPTICAL 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1063834141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORRELL OPTICAL INC

Provider Business Mailing Address
First Line	:	3810 MORRELL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1915
Country	:	US
Telephone Number	:	215-632-6698
Fax Number	:	215-568-0661

Provider Business Practice Location Address
First Line	:	3810 MORRELL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1915
Country	:	US
Telephone Number	:	215-632-6698
Fax Number	:	215-568-0661

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM NIGRO
Credential	:
Telephone Number	:	215-632-6698

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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Directions to “MORRELL OPTICAL INC ” Practice Location

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