MEDICARE: CITI CENTER OPTICAL INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1235431750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITI CENTER OPTICAL INC

Provider Business Mailing Address
First Line	:	1182 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7005
Country	:	US
Telephone Number	:	718-495-2065
Fax Number	:	718-495-2006

Provider Business Practice Location Address
First Line	:	1182 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7005
Country	:	US
Telephone Number	:	718-495-2065
Fax Number	:	718-495-2006

Authorized Official
Title or Position	:	OWNER
Name	:	YACOUBA KONATE
Credential	:
Telephone Number	:	718-495-2065

Provider Enumeration Date	:	12/04/2010
Last Update Date	:	01/21/2021

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