MEDICARE: EVELYN K HANCOCK

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	332B00000X	Durable Medical Equipment & Medical Supplies	11422	TX

General Provider Information

NPI Number	:	1417128612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYN K HANCOCK

Provider Business Mailing Address
First Line	:	207 E SAN ANTONIO ST.
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624
Country	:	US
Telephone Number	:	830-997-4800
Fax Number	:	830-990-1427

Provider Business Practice Location Address
First Line	:	207 E SAN ANTONIO ST
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4137
Country	:	US
Telephone Number	:	830-997-4800
Fax Number	:	830-990-1427

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	MRS. EVELYN K HANCOCK
Credential	:
Telephone Number	:	830-997-4800

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	04/10/2008

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Directions to “EVELYN K HANCOCK ” Practice Location

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