MEDICARE: AVENUE D OPTICIANS 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	156FX1800X	Optician	0042251	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093883746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENUE D OPTICIANS INC

Provider Business Mailing Address
First Line	:	4403 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5725
Country	:	US
Telephone Number	:	718-629-9490
Fax Number	:	718-451-0494

Provider Business Practice Location Address
First Line	:	4403 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5725
Country	:	US
Telephone Number	:	718-629-9490
Fax Number	:	718-451-0494

Authorized Official
Title or Position	:	PRES OPTICIAN
Name	:	MR. STUART N KING
Credential	:
Telephone Number	:	718-629-9490

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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Directions to “AVENUE D OPTICIANS INC ” Practice Location

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