MEDICARE: MR. OLEG LIBEROV OPTICIAN

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	007577-1	NY

General Provider Information

NPI Number	:	1447495882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OLEG LIBEROV OPTICIAN

Provider Business Mailing Address
First Line	:	782 NORMAN DR
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1322
Country	:	US
Telephone Number	:	718-353-7352
Fax Number	:	718-353-7563

Provider Business Practice Location Address
First Line	:	2521 PARSONS BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-1247
Country	:	US
Telephone Number	:	718-353-7352
Fax Number	:	718-353-7563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	12/15/2008

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