MEDICARE: 3 VISIONS OPHTHALMOLOGY P.C.

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	207W00000X	Ophthalmology Physician	212050	NY

General Provider Information

NPI Number	:	1003078718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3 VISIONS OPHTHALMOLOGY P.C.

Provider Business Mailing Address
First Line	:	117 DECATUR ST
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2513
Country	:	US
Telephone Number	:	718-455-2295
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 DECATUR ST
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2513
Country	:	US
Telephone Number	:	718-455-2295
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	RONDAI EVANS
Credential	:	M.D.
Telephone Number	:	718-455-2295

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	08/13/2008

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