MEDICARE: INVERRARY OPTICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies	1489	FL

General Provider Information

NPI Number	:	1437329778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVERRARY OPTICAL INC.

Provider Business Mailing Address
First Line	:	2000 N FEDERAL HWY
Second Line	:	STE 100
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-942-7717
Fax Number	:	954-942-2248

Provider Business Practice Location Address
First Line	:	2000 N FEDERAL HWY
Second Line	:	STE 100
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-942-7717
Fax Number	:	954-942-2248

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAWRENCE M GOULD SR.
Credential	:	OPTICIAN
Telephone Number	:	954-942-7717

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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