NPI: 1902466659 · SACATON, AZ 85147 · 390200000X
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 127 | $4K |
| 2021 | 203 | $5K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2025 | Eyeglasses delux frames | 65 | 65 | $3K |
| 92014 | 44 | 44 | $1K | |
| V2020 | Vision svcs frames purchases | 48 | 47 | $1K |
| 92340 | 66 | 66 | $975.00 | |
| 92004 | 32 | 31 | $864.00 | |
| V2100 | Lens spher single plano 4.00 | 15 | 15 | $441.00 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 40 | 36 | $90.00 |
| V2784 | Lens polycarb or equal | 20 | 20 | $0.00 |