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NPI Code Detail

MEDICARE: BAZAN OPTOMETRIC SERVICES LLC

MEDICARE: BAZAN OPTOMETRIC SERVICES 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
1152W00000XOptometrist006867NY

General Provider Information

NPI Number : 1134517584
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAZAN OPTOMETRIC SERVICES LLC
Provider Business Mailing Address
First Line : 682 UNION ST
Second Line : PARK SLOPE EYE
City : BROOKLYN
State : NY
Zip : 11215-2047
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 815 HUTCHINSON RIVER PKWY
Second Line : INSIDE TARGET OPTICAL
City : BRONX
State : NY
Zip : 10465-1887
Country : US
Telephone Number : 718-822-2305
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JUSTIN BAZAN
Credential : O.D.
Telephone Number : 646-496-7365
Provider Enumeration Date : 01/07/2015
Last Update Date : 08/06/2015

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Directions to “BAZAN OPTOMETRIC SERVICES LLC ” Practice Location

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