MEDICARE: MAR OPTICAL INC.

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	156FX1800X	Optician	4019	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1700919453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAR OPTICAL INC.

Provider Business Mailing Address
First Line	:	2115 E 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4364
Country	:	US
Telephone Number	:	718-336-0600
Fax Number	:	718-336-0649

Provider Business Practice Location Address
First Line	:	2115 EAST 15 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4101
Country	:	US
Telephone Number	:	718-336-0600
Fax Number	:	718-336-0649

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT M KANE
Credential	:	OPT. DISP.
Telephone Number	:	718-336-0600

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/23/2012

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