MEDICARE: ONE HOUR OPTICAL MEDICAL SERVICES, PC

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	:	1275281602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE HOUR OPTICAL MEDICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	1200 E CAMPBELL RD STE 108
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-1963
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 E BAYAUD AVE STE 485
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-3000
Country	:	US
Telephone Number	:	303-321-1606
Fax Number	:	303-321-0920

Authorized Official
Title or Position	:	SR. DIRECTOR OF MANAGED CARE
Name	:	MELISSA ALLISON
Credential	:
Telephone Number	:	314-741-8183

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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