MEDICARE: MR. IGOR SLONY OPTICIAN

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	156FX1100X	Ophthalmic Technician/Technologist	007063-1	NY
2	156FX1100X	Ophthalmic Technician/Technologist	34TD00331300	NJ

General Provider Information

NPI Number	:	1215915731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IGOR SLONY OPTICIAN

Provider Business Mailing Address
First Line	:	11502 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1902
Country	:	US
Telephone Number	:	718-835-8000
Fax Number	:	718-845-5025

Provider Business Practice Location Address
First Line	:	11502 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1902
Country	:	US
Telephone Number	:	718-835-8000
Fax Number	:	718-845-5025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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