MEDICARE: FACTORY EYEGLASS OUTLET, 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	332H00000X	Eyewear Supplier	DR0771	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5786260001	OTHER	TX	MEDICARE DME MAC

General Provider Information

NPI Number	:	1497704001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACTORY EYEGLASS OUTLET, INC.

Provider Business Mailing Address
First Line	:	2421 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1901
Country	:	US
Telephone Number	:	713-668-2885
Fax Number	:	713-668-3373

Provider Business Practice Location Address
First Line	:	2421 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1901
Country	:	US
Telephone Number	:	713-668-2885
Fax Number	:	713-668-3373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN BRUCE GINSBERG
Credential	:
Telephone Number	:	713-668-2885

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/06/2008

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Directions to “FACTORY EYEGLASS OUTLET, INC. ” Practice Location

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