MEDICARE: AVS VISION RUFE SNOW LLC

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	:	1417523226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVS VISION RUFE SNOW LLC

Provider Business Mailing Address
First Line	:	5228 RUFE SNOW DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5228 RUFE SNOW DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6652
Country	:	US
Telephone Number	:	561-275-2020
Fax Number	:	561-828-8367

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DANIEL GARZA
Credential	:
Telephone Number	:	561-720-6423

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/02/2021

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