MEDICARE: J. LOUIS EYECARE, LLC

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	332H00000X	Eyewear Supplier	TUV0065541	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	:	1396985107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. LOUIS EYECARE, LLC

Provider Business Mailing Address
First Line	:	2922 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4639
Country	:	US
Telephone Number	:	718-513-6911
Fax Number	:	718-513-6912

Provider Business Practice Location Address
First Line	:	2618 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5012
Country	:	US
Telephone Number	:	212-666-2615
Fax Number	:	212-400-6255

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JEAN CLAUDY LOUIS
Credential	:	O.D.
Telephone Number	:	212-666-2675

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	07/23/2019

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