MEDICARE: BANVILLE OPTICAL 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	156FX1800X	Optician	4281	MA

General Provider Information

NPI Number	:	1912059882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANVILLE OPTICAL INC.

Provider Business Mailing Address
First Line	:	88 LAFAYETTE ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-3625
Country	:	US
Telephone Number	:	978-745-2774
Fax Number	:	978-745-9317

Provider Business Practice Location Address
First Line	:	88 LAFAYETTE ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-3625
Country	:	US
Telephone Number	:	978-745-2774
Fax Number	:	978-745-9317

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD J RIZKALLA
Credential	:	R.D.O.
Telephone Number	:	978-745-2774

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	02/08/2011

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Directions to “BANVILLE OPTICAL INC. ” Practice Location

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