MEDICARE: RUTH SUN O.D.

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	T005999	NY

General Provider Information

NPI Number	:	1235362559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH SUN O.D.

Provider Business Mailing Address
First Line	:	19 BITTERSWEET LN
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-1617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 BITTERSWEET LN
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-1617
Country	:	US
Telephone Number	:	516-759-5574
Fax Number	:

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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