MEDICARE: MAYER OPTICAL SHOP, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1831197409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYER OPTICAL SHOP, INC.

Provider Business Mailing Address
First Line	:	1736 COPE AVE E
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-2610
Country	:	US
Telephone Number	:	651-770-2975
Fax Number	:	651-748-1452

Provider Business Practice Location Address
First Line	:	1736 COPE AVE E
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-2610
Country	:	US
Telephone Number	:	651-770-2975
Fax Number	:	651-748-1452

Authorized Official
Title or Position	:	OPTICIAN/PRESIDENT
Name	:	MR. OTTO P. MAYER JR.
Credential	:	OPTICIAN
Telephone Number	:	651-770-2975

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/23/2010

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Directions to “MAYER OPTICAL SHOP, INC. ” Practice Location

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