MEDICARE: EYEMASTERS OF TEXAS LTD

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	:	1841382470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMASTERS OF TEXAS LTD

Provider Business Mailing Address
First Line	:	PO BOX 848448
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8448
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	2370 N EXPRESSWAY
Second Line	:	SPACE1532
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-1106
Country	:	US
Telephone Number	:	956-544-6405
Fax Number	:	956-544-6407

Authorized Official
Title or Position	:	OFFICER
Name	:	DOUG NEWCOM
Credential	:
Telephone Number	:	210-524-6700

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/27/2008

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