MEDICARE: LYUBOMYRA KOLESNYK

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	156FX1800X	Optician	008716-1	NY
2	156FX1100X	Ophthalmic Technician/Technologist	008716-1	NY

General Provider Information

NPI Number	:	1265600969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUBOMYRA KOLESNYK

Provider Business Mailing Address
First Line	:	PO BOX 290740
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-0740
Country	:	US
Telephone Number	:	718-915-0791
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2023
Country	:	US
Telephone Number	:	718-622-2020
Fax Number	:

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

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	06/03/2008

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Directions to “ LYUBOMYRA KOLESNYK ” Practice Location

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