=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881037760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE TWO I-CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 04/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1577 E 18TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-819-9560
-----------------------------------------------------
Fax | 347-896-5559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1577 E 18TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-819-9560
-----------------------------------------------------
Fax | 347-896-5559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE MASHA FRIEDMAN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 718-819-9560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 007276
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------