MEDICARE: DR. BRIAN NYE OD

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	TUV0036651	NY

General Provider Information

NPI Number	:	1093851685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN NYE OD

Provider Business Mailing Address
First Line	:	334 CORTELYOU AVENUE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312
Country	:	US
Telephone Number	:	718-984-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	482 86TH STREET
Second Line	:	LAMS LAB EXPRESS
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4708
Country	:	US
Telephone Number	:	718-921-5488
Fax Number	:	718-238-2148

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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