MEDICARE: OPTICAL IDEAS

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

General Provider Information

NPI Number	:	1003006867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL IDEAS

Provider Business Mailing Address
First Line	:	2168 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1406
Country	:	US
Telephone Number	:	718-931-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2168 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1406
Country	:	US
Telephone Number	:	718-931-0500
Fax Number	:

Authorized Official
Title or Position	:	PRES.
Name	:	MR. STANLEY ROTH
Credential	:
Telephone Number	:	718-931-0500

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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Directions to “OPTICAL IDEAS ” Practice Location

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