MEDICARE: EYELAND VISION OPTIQUE

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	008251-1	NY

General Provider Information

NPI Number	:	1275660698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYELAND VISION OPTIQUE

Provider Business Mailing Address
First Line	:	900 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2015
Country	:	US
Telephone Number	:	718-420-6191
Fax Number	:	718-420-6191

Provider Business Practice Location Address
First Line	:	900 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2015
Country	:	US
Telephone Number	:	718-420-6191
Fax Number	:	718-420-6191

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MS. LYUDMILA KUBYNINA
Credential	:
Telephone Number	:	718-420-6191

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	01/28/2011

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Directions to “EYELAND VISION OPTIQUE ” Practice Location

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