MEDICARE: BRISTOL 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	4854	NY
2	152W00000X	Optometrist		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	:	1144391749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISTOL OPTICIANS INC.

Provider Business Mailing Address
First Line	:	949 PENNSYLVANIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-8416
Country	:	US
Telephone Number	:	718-649-6526
Fax Number	:	718-272-3722

Provider Business Practice Location Address
First Line	:	949 PENNSYLVANIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-8416
Country	:	US
Telephone Number	:	718-649-6526
Fax Number	:	718-272-3722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN SMALL
Credential	:
Telephone Number	:	718-649-6526

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/11/2025

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