Healthcare Provider Details

I. General information

NPI: 1770906778
Provider Name (Legal Business Name): OPTICARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 FOSTER AVE SUITE 4B
BROOKLYN NY
11230-1399
US

IV. Provider business mailing address

620 FOSTER AVE SUITE 4B
BROOKLYN NY
11230-1399
US

V. Phone/Fax

Practice location:
  • Phone: 718-269-4888
  • Fax: 718-269-4889
Mailing address:
  • Phone: 718-269-4888
  • Fax: 718-269-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENI WALLACE
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 718-269-4888