MEDICARE: STEVEN JOHN OPTICIANS PLLC

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	T005029	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	:	1235291535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN JOHN OPTICIANS PLLC

Provider Business Mailing Address
First Line	:	5901 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1602
Country	:	US
Telephone Number	:	718-543-3336
Fax Number	:	718-543-6463

Provider Business Practice Location Address
First Line	:	5901 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1602
Country	:	US
Telephone Number	:	718-543-3336
Fax Number	:	718-543-6463

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CATHERINE DUHAUDT
Credential	:
Telephone Number	:	718-543-3336

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/08/2016

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