MEDICARE: MASTER OPTICS OPTICAL

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	305S00000X	Point of Service	NOT REQUIRED

General Provider Information

NPI Number	:	1417141805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTER OPTICS OPTICAL

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

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

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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Directions to “MASTER OPTICS OPTICAL ” Practice Location

Language	Start Address	Practice Location

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