MEDICARE: CITY OPTICAL 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1295261113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OPTICAL LLC

Provider Business Mailing Address
First Line	:	2406 GUS THOMASSON RD
Second Line	:	SUITE A
City	:	DALLAS
State	:	TX
Zip	:	75228-3007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 GUS THOMASSON RD
Second Line	:	SUITE A
City	:	DALLAS
State	:	TX
Zip	:	75228-3007
Country	:	US
Telephone Number	:	469-733-2074
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARIA ADRIANA PALACIOS- LANDIN
Credential	:
Telephone Number	:	469-733-2074

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “CITY OPTICAL LLC ” Practice Location

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