MEDICARE: WINDSOR OPTICAL

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1205077898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR OPTICAL

Provider Business Mailing Address
First Line	:	458 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6027
Country	:	US
Telephone Number	:	212-696-5990
Fax Number	:

Provider Business Practice Location Address
First Line	:	458 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6027
Country	:	US
Telephone Number	:	212-696-5990
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JEFF STONE
Credential	:	OPTICIAN
Telephone Number	:	212-696-5990

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	07/09/2014

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Directions to “WINDSOR OPTICAL ” Practice Location

Language	Start Address	Practice Location

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