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NPI Code Detail

MEDICARE: OPTIQUE ELEGANCE OF NEW YORK, INC.

MEDICARE: OPTIQUE ELEGANCE OF NEW YORK, 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
1156FX1800XOptician4931NY

General Provider Information

NPI Number : 1386865756
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIQUE ELEGANCE OF NEW YORK, INC.
Provider Business Mailing Address
First Line : 1552 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-4716
Country : US
Telephone Number : 718-258-0315
Fax Number : 718-258-6622
Provider Business Practice Location Address
First Line : 1552 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-4716
Country : US
Telephone Number : 718-258-0315
Fax Number : 718-258-6622
Authorized Official
Title or Position : CEO
Name : MRS. PHYLLIS BUDNITZ
Credential : OPTICIAN
Telephone Number : 718-258-0315
Provider Enumeration Date : 05/01/2007
Last Update Date : 08/22/2020

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