MEDICARE: AMERICAN EYEWEAR 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	DR2632	TX

General Provider Information

NPI Number	:	1295931194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN EYEWEAR INC.

Provider Business Mailing Address
First Line	:	8309 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5510
Country	:	US
Telephone Number	:	214-750-5793
Fax Number	:	214-750-6668

Provider Business Practice Location Address
First Line	:	8309 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5510
Country	:	US
Telephone Number	:	214-750-5793
Fax Number	:	214-750-6668

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LAWRENCE STEPHEN BERK
Credential	:
Telephone Number	:	214-750-5793

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/13/2012

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Directions to “AMERICAN EYEWEAR INC. ” Practice Location

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