MEDICARE: RAMON IGLESIAS

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	NY	NY

General Provider Information

NPI Number	:	1588981997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON IGLESIAS

Provider Business Mailing Address
First Line	:	3354 BROADWAY # 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7401
Country	:	US
Telephone Number	:	212-234-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	3354 BROADWAY # 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7401
Country	:	US
Telephone Number	:	212-234-7494
Fax Number	:

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

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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Directions to “ RAMON IGLESIAS ” Practice Location

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