MEDICARE: DR. ISAYAS TEKLE TEKIE D.O

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	152W00000X	Optometrist	56 007501	NY

General Provider Information

NPI Number	:	1487984324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAYAS TEKLE TEKIE D.O

Provider Business Mailing Address
First Line	:	922A FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4018
Country	:	US
Telephone Number	:	718-862-3665
Fax Number	:

Provider Business Practice Location Address
First Line	:	922A FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4018
Country	:	US
Telephone Number	:	718-862-3665
Fax Number	:

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

Provider Enumeration Date	:	12/26/2009
Last Update Date	:	01/20/2011

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