MEDICARE: SVC OF BENSONHURST LLC

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1356095608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SVC OF BENSONHURST LLC

Provider Business Mailing Address
First Line	:	1224 OSTRANDER AVE
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2109
Country	:	US
Telephone Number	:	631-727-2858
Fax Number	:	631-727-2866

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	:	718-837-0783

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY S WILLIAMS JR.
Credential	:	OD
Telephone Number	:	631-727-2858

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	12/06/2022

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