MEDICARE: MASTER OPTICS OPITCAL 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	8710421	IL

General Provider Information

NPI Number	:	1346541711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTER OPTICS OPITCAL INC

Provider Business Mailing Address
First Line	:	3128 FOREST LN
Second Line	:	SUITE 252
City	:	DALLAS
State	:	TX
Zip	:	75234-7726
Country	:	US
Telephone Number	:	972-243-3373
Fax Number	:

Provider Business Practice Location Address
First Line	:	3128 FOREST LN
Second Line	:	SUITE 252
City	:	DALLAS
State	:	TX
Zip	:	75234-7726
Country	:	US
Telephone Number	:	972-243-3373
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ADDA O MEDINA
Credential	:
Telephone Number	:	972-243-3373

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	11/16/2010

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Directions to “MASTER OPTICS OPITCAL INC ” Practice Location

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