MEDICARE: MRS. EVELYN KAY HANCOCK

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1487723185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN KAY HANCOCK

Provider Business Mailing Address
First Line	:	207 E SAN ANTONIO ST
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4137
Country	:	US
Telephone Number	:	830-997-4800
Fax Number	:	830-990-1427

Provider Business Practice Location Address
First Line	:	207 E SAN ANTONIO ST
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4137
Country	:	US
Telephone Number	:	830-997-4800
Fax Number	:	830-990-1427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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