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NPI Code Detail

MEDICARE: FAMILY OPTOMETRY CARE PC

MEDICARE: FAMILY OPTOMETRY CARE PC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1417415886
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY OPTOMETRY CARE PC
Provider Business Mailing Address
First Line : 10 LINDEN ST
Second Line :
City : WOODMERE
State : NY
Zip : 11598-2620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 WADSWORTH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10033-6102
Country : US
Telephone Number : 718-534-0689
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MARKIEL YAKUBOV
Credential :
Telephone Number : 718-534-0689
Provider Enumeration Date : 03/05/2019
Last Update Date : 03/05/2019

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Directions to “FAMILY OPTOMETRY CARE PC ” Practice Location

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