MEDICARE: PRO OPTICS CORP

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	TUV005957-1	NY

General Provider Information

NPI Number	:	1013171149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO OPTICS CORP

Provider Business Mailing Address
First Line	:	2483 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5443
Country	:	US
Telephone Number	:	718-933-0187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2483 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5443
Country	:	US
Telephone Number	:	718-933-0187
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT
Name	:	MICHELLE ERICKSEN
Credential	:
Telephone Number	:	718-933-0187

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	03/06/2018

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Directions to “PRO OPTICS CORP ” Practice Location

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