MEDICARE: DESIGNER OPTICAL OF PELHAM

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1689912206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESIGNER OPTICAL OF PELHAM

Provider Business Mailing Address
First Line	:	2196 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1406
Country	:	US
Telephone Number	:	718-513-3577
Fax Number	:	718-513-3579

Provider Business Practice Location Address
First Line	:	2196 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1406
Country	:	US
Telephone Number	:	718-513-3577
Fax Number	:	718-513-3579

Authorized Official
Title or Position	:	OWNER
Name	:	AVI CHOAI
Credential	:
Telephone Number	:	718-513-3577

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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Directions to “DESIGNER OPTICAL OF PELHAM ” Practice Location

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