MEDICARE: EFFIE TATAKIS O.D.

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	004950	NY

General Provider Information

NPI Number	:	1003055039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFFIE TATAKIS O.D.

Provider Business Mailing Address
First Line	:	2019 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2549
Country	:	US
Telephone Number	:	718-434-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2172 E 38TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4930
Country	:	US
Telephone Number	:	718-434-0711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2009
Last Update Date	:	10/10/2018

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