MEDICARE: EYEMAX 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1225329626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMAX OPTICAL INC.

Provider Business Mailing Address
First Line	:	1515 N TOWN EAST BLVD
Second Line	:	SUITE 523
City	:	MESQUITE
State	:	TX
Zip	:	75150-4157
Country	:	US
Telephone Number	:	972-850-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N TOWN EAST BLVD
Second Line	:	SUITE 523
City	:	MESQUITE
State	:	TX
Zip	:	75150-4157
Country	:	US
Telephone Number	:	972-850-8001
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MALIK MAMDANI
Credential	:
Telephone Number	:	972-850-8001

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	04/20/2011

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