MEDICARE: DR. FARNOUSH SHAHKOHI O.D.

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	TUV56006926	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	:	1144204702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARNOUSH SHAHKOHI O.D.

Provider Business Mailing Address
First Line	:	14 MORRIS LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1707
Country	:	US
Telephone Number	:	516-707-5145
Fax Number	:	347-887-5000

Provider Business Practice Location Address
First Line	:	14 MORRIS LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1707
Country	:	US
Telephone Number	:	516-707-5145
Fax Number	:	347-887-5000

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	04/15/2015

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