MEDICARE: RONDAI EVANS MD

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	207W00000X	Ophthalmology Physician	212050	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295744357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDAI EVANS MD

Provider Business Mailing Address
First Line	:	117 DECATUR ST
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2513
Country	:	US
Telephone Number	:	718-455-2295
Fax Number	:	718-455-2297

Provider Business Practice Location Address
First Line	:	117 DECATUR ST
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2513
Country	:	US
Telephone Number	:	718-455-2295
Fax Number	:	718-455-2297

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	06/13/2012

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Directions to “ RONDAI EVANS MD” Practice Location

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