MEDICARE: AMEDCO PENNSYLVANIA LLC

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	152W00000X	Optometrist		PA
2	207W00000X	Ophthalmology Physician		PA

General Provider Information

NPI Number	:	1629312780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEDCO PENNSYLVANIA LLC

Provider Business Mailing Address
First Line	:	8076 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7930
Country	:	US
Telephone Number	:	877-881-0022
Fax Number	:	702-543-0314

Provider Business Practice Location Address
First Line	:	2500 DEKALB PIKE
Second Line	:	#301
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-2007
Country	:	US
Telephone Number	:	610-272-1644
Fax Number	:	610-272-3210

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ERICA PERREIRA
Credential	:
Telephone Number	:	877-881-0022

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “AMEDCO PENNSYLVANIA LLC ” Practice Location

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