MEDICARE: US VISION GROUP LLC

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	7845T	TX

General Provider Information

NPI Number	:	1093083636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US VISION GROUP LLC

Provider Business Mailing Address
First Line	:	1515 N TOWN EAST BLVD
Second Line	:	SUITE 523B
City	:	MESQUITE
State	:	TX
Zip	:	75150-4157
Country	:	US
Telephone Number	:	972-638-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N TOWN EAST BLVD
Second Line	:	SUITE 523B
City	:	MESQUITE
State	:	TX
Zip	:	75150-4157
Country	:	US
Telephone Number	:	972-638-8600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TASNEEM MAMDANI
Credential	:	O.D.
Telephone Number	:	505-232-2020

Provider Enumeration Date	:	12/10/2011
Last Update Date	:	12/10/2011

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