MEDICARE: SURY 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1548291768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURY OPTICAL, INC.

Provider Business Mailing Address
First Line	:	650 SPRING HILL RING RD
Second Line	:	SUITE 2020
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1296
Country	:	US
Telephone Number	:	847-551-1322
Fax Number	:	847-426-0299

Provider Business Practice Location Address
First Line	:	650 SPRING HILL RING RD
Second Line	:	SUITE 2020
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1296
Country	:	US
Telephone Number	:	847-551-1322
Fax Number	:	847-426-0299

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEBORAH J. SURY
Credential	:
Telephone Number	:	847-551-1322

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	05/13/2008

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