MEDICARE: S G OPTICAL

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	005583-1	NY

General Provider Information

NPI Number	:	1376058917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S G OPTICAL

Provider Business Mailing Address
First Line	:	291 N MAIN ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-2924
Country	:	US
Telephone Number	:	845-352-2878
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 N MAIN ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-2924
Country	:	US
Telephone Number	:	845-352-2878
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGE EPSTEIN
Credential	:
Telephone Number	:	845-352-2878

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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Directions to “S G OPTICAL ” Practice Location

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