MEDICARE: SOLOMON MATATOV

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	455492408	NY

General Provider Information

NPI Number	:	1215373667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOLOMON MATATOV

Provider Business Mailing Address
First Line	:	10505 CROSSBAY BLVD
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11417-1514
Country	:	US
Telephone Number	:	718-366-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 CROSSBAY BLVD
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11417-1514
Country	:	US
Telephone Number	:	718-366-8193
Fax Number	:

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

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	05/02/2018

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Directions to “ SOLOMON MATATOV ” Practice Location

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