MEDICARE: DISCOUNT EYEGLASS OUTLET

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	D05042	FL

General Provider Information

NPI Number	:	1447396767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOUNT EYEGLASS OUTLET

Provider Business Mailing Address
First Line	:	14590 MILITARY TRL
Second Line	:	SUITE E-1
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3757
Country	:	US
Telephone Number	:	561-637-4071
Fax Number	:	561-637-4072

Provider Business Practice Location Address
First Line	:	14590 MILITARY TRL
Second Line	:	SUITE E-1
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3757
Country	:	US
Telephone Number	:	561-637-4071
Fax Number	:	561-637-4072

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE E GILTMAN
Credential	:	LIC OPTICIAN
Telephone Number	:	561-637-4071

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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Directions to “DISCOUNT EYEGLASS OUTLET ” Practice Location

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