MEDICARE: FOR EYES OPTICAL CO OF PENNSYLVANIA

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	:	1619052685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOR EYES OPTICAL CO OF PENNSYLVANIA

Provider Business Mailing Address
First Line	:	1111 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-3531
Country	:	US
Telephone Number	:	804-648-5620
Fax Number	:	804-648-6114

Provider Business Practice Location Address
First Line	:	1111 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-3531
Country	:	US
Telephone Number	:	804-648-5620
Fax Number	:	804-648-6114

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JEFFRY MARTIN
Credential	:
Telephone Number	:	305-557-9004

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	01/23/2008

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