MEDICARE: OCEAN EYES OPTICAL 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	007046-01	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	:	1316989619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN EYES OPTICAL INC.

Provider Business Mailing Address
First Line	:	2907 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3201
Country	:	US
Telephone Number	:	718-332-1017
Fax Number	:	718-332-1354

Provider Business Practice Location Address
First Line	:	2907 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3201
Country	:	US
Telephone Number	:	718-332-1017
Fax Number	:	718-332-1354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LEE WEISSMAN
Credential	:	DISPENSER
Telephone Number	:	718-332-1017

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/10/2016

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