MEDICARE: ROOSEVELT OPTOMETRY ASSOCIATES PLLC

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1356116396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOSEVELT OPTOMETRY ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	9109 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9109 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7995
Country	:	US
Telephone Number	:	516-343-4003
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/PRESIDENT/OD
Name	:	DR. SANAZ OORIEL
Credential	:	OD
Telephone Number	:	718-269-1198

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	07/15/2024

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