MEDICARE: OM VISION SERVICES 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	156FX1800X	Optician		CA

General Provider Information

NPI Number	:	1417315706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OM VISION SERVICES INC,

Provider Business Mailing Address
First Line	:	13329 MANCHESTER RD
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-1710
Country	:	US
Telephone Number	:	314-965-4435
Fax Number	:

Provider Business Practice Location Address
First Line	:	13329 MANCHESTER RD
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-1710
Country	:	US
Telephone Number	:	314-965-4435
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/OWNER
Name	:	STELLA ZILBER
Credential	:	OWNER
Telephone Number	:	214-912-7272

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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