MEDICARE: EYE D SUNSET

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	TUV7286	NY

General Provider Information

NPI Number	:	1972994754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE D SUNSET

Provider Business Mailing Address
First Line	:	4913 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2890
Country	:	US
Telephone Number	:	718-889-1921
Fax Number	:	718-889-1925

Provider Business Practice Location Address
First Line	:	4913 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2890
Country	:	US
Telephone Number	:	718-889-1921
Fax Number	:	718-889-1925

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MS. DIANA NGUYEN
Credential	:	O.D.
Telephone Number	:	718-889-1921

Provider Enumeration Date	:	02/14/2015
Last Update Date	:	02/14/2015

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Directions to “EYE D SUNSET ” Practice Location

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