MEDICARE: DR. MASSALA REFFELL, O.D., PLLC

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	152WC0802X	Corneal and Contact Management Optometrist	06876TG	TX
2	152WX0102X	Occupational Vision Optometrist	06876TG	TX
3	152W00000X	Optometrist	06876TG	TX

General Provider Information

NPI Number	:	1700101243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MASSALA REFFELL, O.D., PLLC

Provider Business Mailing Address
First Line	:	6760 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	817-989-2424
Fax Number	:	817-989-2427

Provider Business Practice Location Address
First Line	:	6760 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	817-989-2424
Fax Number	:	817-989-2427

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MASSALA REFFELL
Credential	:	O.D.
Telephone Number	:	817-989-2424

Provider Enumeration Date	:	03/27/2010
Last Update Date	:	03/27/2010

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