MEDICARE: FORDHAM OPTICAL INC

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

General Provider Information

NPI Number	:	1154252039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORDHAM OPTICAL INC

Provider Business Mailing Address
First Line	:	330 E FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5030
Country	:	US
Telephone Number	:	347-269-8907
Fax Number	:	347-269-8909

Provider Business Practice Location Address
First Line	:	330 E FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5030
Country	:	US
Telephone Number	:	347-269-8907
Fax Number	:	347-269-8909

Authorized Official
Title or Position	:	OWNER
Name	:	WALER NESSES
Credential	:
Telephone Number	:	858-692-6338

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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