MEDICARE: JOSEPH CAPETOLA

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	T004266	NY

General Provider Information

NPI Number	:	1205084753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH CAPETOLA

Provider Business Mailing Address
First Line	:	218 PROSPECT PARK W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 PROSPECT PARK W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5802
Country	:	US
Telephone Number	:	718-768-1498
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SCOTT NAGEL
Credential	:
Telephone Number	:	718-768-1498

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	09/08/2008

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Directions to “JOSEPH CAPETOLA ” Practice Location

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