MEDICARE: GURSIMRAN KAUR

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	009398	NY

General Provider Information

NPI Number	:	1538820337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURSIMRAN KAUR

Provider Business Mailing Address
First Line	:	5 HILLS PARK LN
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-4063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11718 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2018
Country	:	US
Telephone Number	:	718-634-5808
Fax Number	:	718-634-8125

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

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	11/17/2025

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Directions to “ GURSIMRAN KAUR ” Practice Location

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