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NPI Code Detail

MEDICARE: GWA OPTICAL LLC

MEDICARE: GWA OPTICAL 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
1152W00000XOptometrist
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1427606680
Entity Type Code : Organization
Provider Name (Legal Business Name) : GWA OPTICAL LLC
Provider Business Mailing Address
First Line : 3601 SW 160TH AVE STE 400
Second Line :
City : MIRAMAR
State : FL
Zip : 33027-6312
Country : US
Telephone Number : 305-557-9004
Fax Number : 855-881-9434
Provider Business Practice Location Address
First Line : 410 N MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4213
Country : US
Telephone Number : 305-557-9004
Fax Number : 855-881-9434
Authorized Official
Title or Position : V.P. OF VISION CLAIMS
Name : MARIA GRIFFITH
Credential :
Telephone Number : 513-292-4137
Provider Enumeration Date : 08/30/2019
Last Update Date : 09/08/2022

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Directions to “GWA OPTICAL LLC ” Practice Location

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