MEDICARE: ANCHOR OPTOMETRIC CARE PC

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	TUV007637-1	NY

General Provider Information

NPI Number	:	1689938474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHOR OPTOMETRIC CARE PC

Provider Business Mailing Address
First Line	:	21714 MERRICK BLVD
Second Line	:
City	:	LAURELTON
State	:	NY
Zip	:	11413-1917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21714 MERRICK BLVD
Second Line	:
City	:	LAURELTON
State	:	NY
Zip	:	11413-1917
Country	:	US
Telephone Number	:	718-978-0100
Fax Number	:	718-978-0101

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CHISOM IWUANYANWU
Credential	:
Telephone Number	:	718-723-4150

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	06/27/2012

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