MEDICARE: DR. JACK OATS M.D.

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	207W00000X	Ophthalmology Physician	170024	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114921558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK OATS M.D.

Provider Business Mailing Address
First Line	:	825 E GATE BLVD
Second Line	:	STE 111
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-2124
Country	:	US
Telephone Number	:	516-804-5200
Fax Number	:	516-240-6540

Provider Business Practice Location Address
First Line	:	4 TECHNOLOGY DR
Second Line	:	SUITE 150
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-4080
Country	:	US
Telephone Number	:	631-941-1400
Fax Number	:	631-941-1476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/17/2019

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