MEDICARE: LUCY'S MEDICAL SUPPLIES 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	332B00000X	Durable Medical Equipment & Medical Supplies		IL

General Provider Information

NPI Number	:	1992816862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCY'S MEDICAL SUPPLIES INC.

Provider Business Mailing Address
First Line	:	8121 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5103
Country	:	US
Telephone Number	:	773-723-9750
Fax Number	:	773-723-9751

Provider Business Practice Location Address
First Line	:	8121 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5103
Country	:	US
Telephone Number	:	773-723-9750
Fax Number	:	773-723-9751

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GORDON ONYKACHUKWU EGBUNA
Credential	:
Telephone Number	:	773-454-3392

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/10/2007

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