MEDICARE: EDUARD SHIMANOV

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	007264	NY

General Provider Information

NPI Number	:	1164546065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARD SHIMANOV

Provider Business Mailing Address
First Line	:	6922 184TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-3538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21411 73RD AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2947
Country	:	US
Telephone Number	:	718-225-5533
Fax Number	:

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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Directions to “ EDUARD SHIMANOV ” Practice Location

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