MEDICARE: THE EYE GALLERY RICE VILLAGE 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	:	1669863858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EYE GALLERY RICE VILLAGE INC

Provider Business Mailing Address
First Line	:	2542 AMHERST ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005
Country	:	US
Telephone Number	:	832-831-7253
Fax Number	:	832-731-7254

Provider Business Practice Location Address
First Line	:	2542 AMHERST ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3238
Country	:	US
Telephone Number	:	832-831-7253
Fax Number	:	832-831-7254

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TINA OZCELIK
Credential	:
Telephone Number	:	832-831-7253

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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