MEDICARE: ALAN R MINKOFF OD

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

General Provider Information

NPI Number	:	1275703464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN R MINKOFF OD

Provider Business Mailing Address
First Line	:	6806 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6806 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5524
Country	:	US
Telephone Number	:	718-236-4352
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ALAN R MINKOFF
Credential	:	OD
Telephone Number	:	718-236-4352

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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