MEDICARE: FOX OPTICAL & GALLERY 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	OE006575P	PA

General Provider Information

NPI Number	:	1174884944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX OPTICAL & GALLERY LLC

Provider Business Mailing Address
First Line	:	28 E 3RD ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18015-1304
Country	:	US
Telephone Number	:	610-332-2400
Fax Number	:	610-332-2402

Provider Business Practice Location Address
First Line	:	28 E 3RD ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18015-1304
Country	:	US
Telephone Number	:	610-332-2400
Fax Number	:	610-332-2402

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY WYNN FOX
Credential	:	O.D.
Telephone Number	:	610-332-2400

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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Directions to “FOX OPTICAL & GALLERY LLC ” Practice Location

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