MEDICARE: WALFRED NASSAU OPTICAL INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	3755	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies	3934	NY

General Provider Information

NPI Number	:	1033276506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALFRED NASSAU OPTICAL INC.

Provider Business Mailing Address
First Line	:	2453 JERICHO TPKE
Second Line	:
City	:	GARDEN CITY PARK
State	:	NY
Zip	:	11040-4710
Country	:	US
Telephone Number	:	516-746-3836
Fax Number	:

Provider Business Practice Location Address
First Line	:	2453 JERICHO TPKE
Second Line	:
City	:	GARDEN CITY PARK
State	:	NY
Zip	:	11040-4710
Country	:	US
Telephone Number	:	516-746-3836
Fax Number	:

Authorized Official
Title or Position	:	SECT. TREAS.
Name	:	MR. FREDRIC BARRY RAPPS
Credential	:	OPHTHALMIC DISPENSER
Telephone Number	:	516-746-3836

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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