MEDICARE: AMYX OPTICAL INC DBA HILLMOOR OPTICAL

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922192368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMYX OPTICAL INC DBA HILLMOOR OPTICAL

Provider Business Mailing Address
First Line	:	8958 S. US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3403
Country	:	US
Telephone Number	:	772-337-6377
Fax Number	:	772-337-9177

Provider Business Practice Location Address
First Line	:	8958 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3403
Country	:	US
Telephone Number	:	772-337-6377
Fax Number	:	772-337-9177

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL AMYX
Credential	:
Telephone Number	:	772-337-6377

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/18/2011

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