MEDICARE: MAGNA VISION OPTOMETRY CARE PC

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	007058	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750494852	OTHER		PERSONAL NPI

General Provider Information

NPI Number	:	1134570351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNA VISION OPTOMETRY CARE PC

Provider Business Mailing Address
First Line	:	124 GLEN COVE RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1718
Country	:	US
Telephone Number	:	516-277-2414
Fax Number	:	516-629-6754

Provider Business Practice Location Address
First Line	:	124 GLEN COVE RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1718
Country	:	US
Telephone Number	:	516-277-2414
Fax Number	:	516-629-6754

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VERANIKA SHERMAN
Credential	:	O.D.
Telephone Number	:	646-610-2222

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	07/12/2016

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