MEDICARE: CATHERINE OPTICAL CENTER

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1235376203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHERINE OPTICAL CENTER

Provider Business Mailing Address
First Line	:	3354 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7401
Country	:	US
Telephone Number	:	212-234-7494
Fax Number	:	212-234-8060

Provider Business Practice Location Address
First Line	:	3354 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-7401
Country	:	US
Telephone Number	:	212-234-7494
Fax Number	:	212-234-8060

Authorized Official
Title or Position	:	OWNER
Name	:	RAYMOND IGLESIAS
Credential	:
Telephone Number	:	212-234-7494

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	01/13/2009

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Directions to “CATHERINE OPTICAL CENTER ” Practice Location

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