MEDICARE: OPTIQUE 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	152W00000X	Optometrist	2366T	TX

General Provider Information

NPI Number	:	1760804868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIQUE INC

Provider Business Mailing Address
First Line	:	3636 MCKINNEY AVE
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75204-1422
Country	:	US
Telephone Number	:	214-252-1800
Fax Number	:	214-252-1801

Provider Business Practice Location Address
First Line	:	3636 MCKINNEY AVE
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75204-1422
Country	:	US
Telephone Number	:	214-252-1800
Fax Number	:	214-252-1801

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. GEORGE EVERETT ORM III
Credential	:	OD
Telephone Number	:	214-252-1800

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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Directions to “OPTIQUE INC ” Practice Location

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