MEDICARE: BALDWIN OPTOMETRY 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	005434	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400042587	OTHER	NY	MEDICARE MEMBER- CHARLES J DELUCA OD- PTAN
3	A100042581	OTHER	NY	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699956037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALDWIN OPTOMETRY PC

Provider Business Mailing Address
First Line	:	2429 GRAND AVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3219
Country	:	US
Telephone Number	:	516-223-0528
Fax Number	:	516-223-0730

Provider Business Practice Location Address
First Line	:	2429 GRAND AVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3219
Country	:	US
Telephone Number	:	516-223-0528
Fax Number	:	516-223-0730

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES J DELUCA
Credential	:	O.D.
Telephone Number	:	516-223-0528

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	04/21/2011

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Directions to “BALDWIN OPTOMETRY PC ” Practice Location

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