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	:	1902060106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMASTERS OF TEXAS LTD

Provider Business Mailing Address
First Line	:	PO BOX 848449
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8449
Country	:	US
Telephone Number	:	210-524-6803
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	5619 LOOP 1604 NORTH
Second Line	:	SUITE 114
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253
Country	:	US
Telephone Number	:	210-647-1808
Fax Number	:

Authorized Official
Title or Position	:	VP MANAGED VISION CARE
Name	:	DOUGLAS ALLAN NEWCOM
Credential	:
Telephone Number	:	210-524-6700

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	10/20/2008

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