MEDICARE: MY OPTICIAN 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	156FX1800X	Optician	007320	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	:	1275501694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY OPTICIAN INC.

Provider Business Mailing Address
First Line	:	9516 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-2434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9516 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-2434
Country	:	US
Telephone Number	:	718-495-8801
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	MARAT SHLIMOV
Credential	:
Telephone Number	:	718-495-8801

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	06/18/2010

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Directions to “MY OPTICIAN INC. ” Practice Location

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