MEDICARE: TKT OPTIQUE

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	:	1417090531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TKT OPTIQUE

Provider Business Mailing Address
First Line	:	3735 PALOMAR CENTRE DR
Second Line	:	SUITE 50
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1147
Country	:	US
Telephone Number	:	859-224-8080
Fax Number	:	859-223-2913

Provider Business Practice Location Address
First Line	:	3735 PALOMAR CENTRE DR
Second Line	:	SUITE 50
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1147
Country	:	US
Telephone Number	:	859-224-8080
Fax Number	:	859-223-2913

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MS. JOYCE BAKER
Credential	:
Telephone Number	:	859-224-8080

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/01/2008

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