MEDICARE: GREAT AMERICAN OPTICAL

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	:	1457519696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT AMERICAN OPTICAL

Provider Business Mailing Address
First Line	:	1831 CHESTNUT ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19103-3713
Country	:	US
Telephone Number	:	215-557-0564
Fax Number	:	215-557-0567

Provider Business Practice Location Address
First Line	:	1831 CHESTNUT ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19103-3713
Country	:	US
Telephone Number	:	215-557-0564
Fax Number	:	215-557-0567

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN PAUL CATRINO
Credential	:
Telephone Number	:	215-557-0564

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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Directions to “GREAT AMERICAN OPTICAL ” Practice Location

Language	Start Address	Practice Location

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