MEDICARE: THE EYEGALSS WORKS, 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1952567968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EYEGALSS WORKS, INC.

Provider Business Mailing Address
First Line	:	4407 MAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1311
Country	:	US
Telephone Number	:	215-487-2711
Fax Number	:	215-487-3647

Provider Business Practice Location Address
First Line	:	4407 MAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1311
Country	:	US
Telephone Number	:	215-487-2711
Fax Number	:	215-487-3647

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JACK GOLDBERG
Credential	:
Telephone Number	:	215-487-2711

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	07/30/2008

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