MEDICARE: FAMILY 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	TUV006926	NY

General Provider Information

NPI Number	:	1861727927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY OPTOMETRIC CARE, PC

Provider Business Mailing Address
First Line	:	14 MORRIS LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1707
Country	:	US
Telephone Number	:	516-707-5145
Fax Number	:	347-887-5000

Provider Business Practice Location Address
First Line	:	14 MORRIS LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1707
Country	:	US
Telephone Number	:	516-707-5145
Fax Number	:	347-887-5000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FARNOUSH SHAHKOHI
Credential	:	OD
Telephone Number	:	516-707-5145

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	04/15/2015

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