MEDICARE: CAROLYN ANNE LONDON 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	156FX1800X	Optician	C003396	NY

General Provider Information

NPI Number	:	1316128143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN ANNE LONDON OPTICIAN

Provider Business Mailing Address
First Line	:	312 ROANOKE AVE
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2723
Country	:	US
Telephone Number	:	631-727-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 ROANOKE AVE
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2723
Country	:	US
Telephone Number	:	631-727-3274
Fax Number	:

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	05/20/2008

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