MEDICARE: EMMETROPIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	156F00000X	Technician/Technologist
2	156FC0800X	Contact Lens Technician/Technologist
3	156FC0801X	Contact Lens Fitter
4	156FX1101X	Ophthalmic Assistant
5	156FX1800X	Optician

General Provider Information

NPI Number	:	1821523465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMETROPIA LLC

Provider Business Mailing Address
First Line	:	7739 NORTHCROSS DR
Second Line	:	SUITE T
City	:	AUSTIN
State	:	TX
Zip	:	78757-1700
Country	:	US
Telephone Number	:	512-458-5367
Fax Number	:	888-454-4279

Provider Business Practice Location Address
First Line	:	7739 NORTHCROSS DR
Second Line	:	SUITE T
City	:	AUSTIN
State	:	TX
Zip	:	78757-1700
Country	:	US
Telephone Number	:	512-458-5367
Fax Number	:	888-454-4279

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. JASON MARCUM
Credential	:
Telephone Number	:	512-458-5367

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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Directions to “EMMETROPIA LLC ” Practice Location

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