MEDICARE: BRONX OPHTHALMOLOGY PC.

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	174400000X	Specialist	254436	NY
2	174400000X	Specialist	133418	NY

General Provider Information

NPI Number	:	1164665469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX OPHTHALMOLOGY PC.

Provider Business Mailing Address
First Line	:	1739 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	718-824-1560
Fax Number	:	718-409-5213

Provider Business Practice Location Address
First Line	:	1739 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	718-824-1560
Fax Number	:	718-409-5213

Authorized Official
Title or Position	:	BILLER
Name	:	MRS. NATHALIE R. DE OLIVEIRA
Credential	:
Telephone Number	:	718-824-1560

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	03/01/2013

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