MEDICARE: SPECX LLC

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	152W00000X	Optometrist	NY004855	NY

General Provider Information

NPI Number	:	1023422144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECX LLC

Provider Business Mailing Address
First Line	:	8310 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4511
Country	:	US
Telephone Number	:	718-680-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	8310 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4511
Country	:	US
Telephone Number	:	718-680-2020
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. ERIC CHARLES RUBINFELD
Credential	:	OD
Telephone Number	:	805-280-1776

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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