MEDICARE: OPTICAL 161 CORP

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	008189	NY

General Provider Information

NPI Number	:	1487958831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL 161 CORP

Provider Business Mailing Address
First Line	:	16111 JAMAICA AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-6113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16111 JAMAICA AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-6113
Country	:	US
Telephone Number	:	718-291-4242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISAK BARAYEV
Credential	:
Telephone Number	:	347-419-2575

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	02/17/2016

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Directions to “OPTICAL 161 CORP ” Practice Location

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