MEDICARE: PA EYEWEAR FACTORY 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	156FX1800X	PA

General Provider Information

NPI Number	:	1073790630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PA EYEWEAR FACTORY INC.

Provider Business Mailing Address
First Line	:	2309 MACARTHUR RD
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-4523
Country	:	US
Telephone Number	:	610-770-0602
Fax Number	:	610-770-0103

Provider Business Practice Location Address
First Line	:	2309 MACARTHUR RD
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-4523
Country	:	US
Telephone Number	:	610-770-0602
Fax Number	:	610-770-0103

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JANE E BESZ
Credential	:
Telephone Number	:	610-770-0602

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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