MEDICARE: ALLANA OPTICAL MANAGEMENT, LLC

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	:	1811661192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLANA OPTICAL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	3940 SAINT FRANCIS AVE STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6162
Country	:	US
Telephone Number	:	956-335-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	3940 SAINT FRANCIS AVE STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6162
Country	:	US
Telephone Number	:	956-335-6476
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JACKIE BENNETT
Credential	:
Telephone Number	:	561-612-4531

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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