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NPI Code Detail

MEDICARE: JOANNA KOMAR OD

MEDICARE: JOANNA KOMAR OD
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
1152W00000XOptometristTUV008333NY

General Provider Information

NPI Number : 1376930099
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNA KOMAR OD
Provider Business Mailing Address
First Line : 11718 ROCKAWAY BEACH BLVD
Second Line :
City : ROCKAWAY PARK
State : NY
Zip : 11694-2018
Country : US
Telephone Number : 718-634-5808
Fax Number :
Provider Business Practice Location Address
First Line : 11718 ROCKAWAY BEACH BLVD
Second Line :
City : ROCKAWAY PARK
State : NY
Zip : 11694-2018
Country : US
Telephone Number : 718-634-5808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2015
Last Update Date : 03/08/2017

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Directions to “ JOANNA KOMAR OD” Practice Location

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