MEDICARE: DR. SPECS OPTICAL, 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	152W00000X	Optometrist	OEG-001130	PA

General Provider Information

NPI Number	:	1891037321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SPECS OPTICAL, PC

Provider Business Mailing Address
First Line	:	2816 AUDUBON VILLAGE DR
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-2262
Country	:	US
Telephone Number	:	610-650-9124
Fax Number	:	610-650-9125

Provider Business Practice Location Address
First Line	:	2816 AUDUBON VILLAGE DR
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-2262
Country	:	US
Telephone Number	:	610-650-9124
Fax Number	:	610-650-9125

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL C RYAN
Credential	:	O.D.
Telephone Number	:	610-540-9124

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	01/10/2014

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