MEDICARE: MISS VINCENT INDELICATO OD

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	C003893-1	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	:	1518147834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VINCENT INDELICATO OD

Provider Business Mailing Address
First Line	:	6819 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4416
Country	:	US
Telephone Number	:	718-236-6090
Fax Number	:	718-236-6090

Provider Business Practice Location Address
First Line	:	6819 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4416
Country	:	US
Telephone Number	:	718-236-6090
Fax Number	:	718-236-6090

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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