MEDICARE: I ADVANTAGE EYECARE, PA

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA7538	OTHER	TX	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1295863454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I ADVANTAGE EYECARE, PA

Provider Business Mailing Address
First Line	:	6509 PRECINCT LINE RD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4313
Country	:	US
Telephone Number	:	817-788-2020
Fax Number	:	817-788-2023

Provider Business Practice Location Address
First Line	:	6509 PRECINCT LINE RD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4313
Country	:	US
Telephone Number	:	817-788-2020
Fax Number	:	817-788-2023

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. ARLENE SCHWARTZ
Credential	:	O.D.
Telephone Number	:	817-788-2020

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	09/21/2011

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