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NPI Code Detail

MEDICARE: DR. AGNESS BLUMKIN DOCTOR OF OPTOMETRY

MEDICARE: DR. AGNESS BLUMKIN DOCTOR OF OPTOMETRY
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
1152W00000XOptometristT006198NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P3332179OTHERNYOXFORD
30101473-05OTHERNYAMERICHOICE

General Provider Information

NPI Number : 1952497778
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AGNESS BLUMKIN DOCTOR OF OPTOMETRY
Provider Business Mailing Address
First Line : 1723 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-3811
Country : US
Telephone Number : 718-998-8400
Fax Number : 718-998-2500
Provider Business Practice Location Address
First Line : 1723 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-3811
Country : US
Telephone Number : 718-998-8400
Fax Number : 718-998-2500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/08/2007

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