MEDICARE: EMX EYE CARE PC

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	:	1770123770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMX EYE CARE PC

Provider Business Mailing Address
First Line	:	3464 PENTAGON BLVD
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-1790
Country	:	US
Telephone Number	:	937-429-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	3464 PENTAGON BLVD
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-1790
Country	:	US
Telephone Number	:	937-429-4060
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	RIMMA LUSKIN
Credential	:
Telephone Number	:	212-729-5303

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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