MEDICARE: HW HOLDINGS

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	:	1679023626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HW HOLDINGS

Provider Business Mailing Address
First Line	:	480 WYLIE DR
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-5405
Country	:	US
Telephone Number	:	309-808-3112
Fax Number	:	312-327-7621

Provider Business Practice Location Address
First Line	:	525 W TOWN CENTER BLVD
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1248
Country	:	US
Telephone Number	:	217-531-5393
Fax Number	:	217-531-9980

Authorized Official
Title or Position	:	INSURANCE SUPERVISOR
Name	:	ERIN BOX
Credential	:
Telephone Number	:	309-808-3112

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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