MEDICARE: 519 EYECARE 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	4946	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	:	1154344075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	519 EYECARE INC.

Provider Business Mailing Address
First Line	:	138 E FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5408
Country	:	US
Telephone Number	:	718-933-0188
Fax Number	:	718-364-7300

Provider Business Practice Location Address
First Line	:	138 E FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5408
Country	:	US
Telephone Number	:	718-933-0188
Fax Number	:	718-364-7300

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. SIEW CHUAN SIN
Credential	:	O.D
Telephone Number	:	718-933-0188

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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