MEDICARE: SIGNATURE OPTICAL

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	:	1659445393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE OPTICAL

Provider Business Mailing Address
First Line	:	25101 CHAGRIN BLVD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5643
Country	:	US
Telephone Number	:	216-831-6299
Fax Number	:	216-292-3486

Provider Business Practice Location Address
First Line	:	25101 CHAGRIN BLVD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5643
Country	:	US
Telephone Number	:	216-831-6299
Fax Number	:	216-292-3486

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL EDWARD MILLSTEIN
Credential	:	M.D.
Telephone Number	:	216-831-0120

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	05/30/2008

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Directions to “SIGNATURE OPTICAL ” Practice Location

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